Amniotomy

(Artificial Rupture of Membranes, ARM)

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Definition

- Intentional artificial rupture of membranes in pregnancy to induce &/or accelerate labour

 

Features

- Stimulates uterine contractions via PGE2

- Possibly assocaited w shorter duration of labour

 

Indications

- IOL

- Labour dystocia

- Placement of FSE

- Assess for MSL

- Prevent fetal aspiration of liquor at delivery

 

Contraindications

- High presenting part, mobile head

- Vasa praevia

- Cautions

-  High head: risk of cord prolapse

 

Equipment

- Amnihook or Amnicot

- Obstetric cream

- Sterile gloves

 

Procedure

- Ensure no placenta praevia or vasa previa on US

- Abdominal palpation

-  Presenting part: cephalic, breech

-  Position

-  Engagement: ensure head engaged

- Patient in lithotomy position or supine

- Naked from waist down

- Chaperone in attendance

- If supine feet together, knees flexed & legs abducted

- Perform VE

-  Feel for membranes

-  +/- Bishops for suitability

- Whilst performing VE place Amnihook between 2 fingers in cervix

-  Ensure hook faces towards palm & not maternal tissues

-  Advance Amnihook until in contact w fetal membranes

-  Rotate Amnihook until hook in contact w membranes

-  Withdraw Amnihook slightly to rupture membranes

- Should feel gush of warm liquid

- Leave hand in place to unsure no prolapse of cord

-  Controlled ARM especially if high head

- Watch for color of liquor

- Document

-  Time & indication for ARM

-  VE findings

-  Color of liqour

 

Complications

- Fetal laceration

- Cord prolapse

- Chorioamnionitis

 

 

 

References

 

WHO RPL: Amniotomy for Shortening Spontaneous Labour

eMedicine: Amniotomy Periprocedural Care, 27/01/2012

eMedicine: Amniotomy Technique, 27/01/2012