An obstetric operation aimed at inducing labor is the opening of the membranes. The procedure is painless and does not affect the health of the mother and fetus.

The waiting period for a baby is beautiful time in the life of every woman, which is accompanied by various problems and not particularly pleasant moments.

One of these moments is the absence of contractions. If labor does not begin for too long, doctors may decide to stimulate it. The most popular option for inducing labor is puncture of the amniotic sac. The manipulation is completely safe for the health of the woman and baby, and does not cause any pain.

Indications for amniotomy

Puncture of the amniotic sac - view surgical intervention, which is completely painless and is performed without anesthesia. It is carried out according to medical indications, under the supervision of a qualified physician. Amniotomy may be recommended both before the onset of labor, in order to simulate it, and during the inactive (sluggish) process of delivery.

Reasons for carrying out this manipulation:

• pregnancy lasts longer than expected. If all the established deadlines for the onset of contractions have already passed, but labor has not begun;
• gestosis in late pregnancy. This complication threatens oxygen starvation of the fetus;
• chronic circulatory disorders between the placenta and the fetus, when oxygen starvation increases and cannot be eliminated with medication;
• a large amount of amniotic fluid. This pathology can cause hypoxia and fetal injuries. For this reason, even with a slight opening of the cervix, doctors puncture the bladder to avoid possible complications;
• ineffective contractions;
• the bubble is flat;
• low attached placenta. A puncture when the placenta is low helps to avoid uterine bleeding and premature detachment;
• Rhesus conflict;
• dense shells. If the cervix is ​​completely open and the bladder has not burst, then doctors perform this manipulation in order to preserve the baby’s health.

How to puncture the amniotic sac

Amniotomy is an obstetric operation that takes a few minutes and is completely harmless. The puncture procedure is performed exclusively by a gynecologist, and not by an obstetrician.

The manipulation is carried out directly during a vaginal examination in a gynecological chair. To do this, the external genital organs are initially treated with an antiseptic, then the doctor carefully punctures the amniotic sac with a special medical sterile instrument. The tool for this procedure is made of plastic and is visually similar to a crochet hook.

For what period

The puncture is prescribed to expectant mothers when they are 41-42 weeks pregnant, if the uterus is already ready for labor but there is no activity.

Is it possible to pierce without contractions?

The bladder can be punctured before labor begins. The main reason for this procedure is to stimulate contractions late in pregnancy or when the cervix is ​​fully dilated.

Piercing process

This type of surgery is performed exclusively by the doctor who will deliver the baby. The procedure is performed during a vaginal examination, the puncture is carried out with a special medical device. After the manipulation, doctors monitor the baby’s heartbeat throughout the entire period.

The puncture process is not dangerous for the woman and her baby. But it stimulates the onset of labor, speeds up contractions, and helps the baby to be born faster.

Does it hurt to pierce a bladder?

Obstetric intervention to puncture the bladder does not cause pain, since it does not have any nerve endings.

How long after the amniotic sac is punctured will contractions begin?

If the bladder was punctured during the prenatal period, then normally contractions should be expected over the next two hours. At this time, doctors connect the woman to a CTG machine to monitor the baby’s condition and readiness for labor.

In a situation where contractions have not occurred after a set time, doctors decide to stimulate them with the help of special drugs.

This is due to the fact that for an unborn child, being in an anhydrous state for more than 12 hours poses a huge danger. If stimulant drugs do not help in delivery, then the expectant mother undergoes an emergency caesarean section procedure.

Is childbirth different after amniotomy?

During a natural puncture of the bladder, oxytocin is released and the uterus begins to contract naturally. After amniotomy manipulation, labor proceeds as well as after stimulation, no difference is observed. But before piercing the amniotic sac, the doctor must:

• examine the woman’s birth canal and assess how ready it is for the birth process;
• determine the degree of cervical dilatation. If a woman is already 41 or 42 weeks pregnant, and there are no contractions, the cervix is ​​soft, thin and elastic, then this manipulation can be performed. But a puncture is not recommended if the expectant mother’s birth canal is not yet prepared for labor;
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Puncture of the amniotic sac, or amniotomy, is done very often - in more than 50% of birth cases. The procedure does not pose a danger to either the woman or the child. The amniotic sac is an elastic membrane that contains the baby. The bubble is filled amniotic fluid. No noise penetrates through it, and the child is not afraid of infections.

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How is the amniotic sac pierced to induce labor?

During contractions, the uterus begins to compress the amniotic sac, causing the fluid to move downward. There part remains and when the muscles contract, it presses on the cervix. This promotes further opening. The bubble penetrates deeper and breaks under increasing pressure. Then the amniotic fluid pours out. In this case, they say that the water has broken. This course of events is considered the norm.

Why do they pierce it specifically?

Why the bladder is pierced before childbirth is determined in each individual case. This can be either planned before the onset of contractions or done urgently during labor.

In order not to be tormented by the question of why the bladder is pierced before childbirth on purpose, it is better to study this topic in advance. There are times when it is necessary to puncture the bladder before childbirth. It is carried out according to the doctor's indications. These include:

1. Weak labor.
2. Preeclampsia in pregnant women acute form. Late, accompanied by swelling of the legs, high blood pressure, deterioration.
3. Life-threatening for mother or child.
4. Fetal hypoxia, suspicion of it.
5. Placental abruption.
6. The bubble has an irregular shape, flat. The membrane is located on the head of the fetus and prevents it from moving along the cervix.
7. Dense membranes of the membranes. The opening is maximum, and the bubble is intact.
8. Pregnancy with more than one fetus. After the birth of the first, the bladder of the second and subsequent ones is pierced.

In case of gestosis, premature placental abruption, post-term pregnancy, the bladder is punctured before childbirth without contractions. Other indications appear after the onset of labor.

When the bladder is specially pierced during childbirth, they must warn about this in advance. Often, the mother in labor is required to provide written consent for the operation. How long labor lasts after puncture of the bladder depends on further activity.

Does it hurt?

One of the exciting questions is whether it hurts to pierce the bladder before childbirth. Many women in labor claim that they experienced very discomfort. In a calm environment, you may not feel the bubble bursting before childbirth. Understanding occurs after the pouring out of the waters. You can get similar sensations by pouring a glass of warm water on your feet. It is in this volume that the amniotic fluid initially comes out.

Puncture of the bladder does not cause pain; the membrane has no nerve endings. When contractions begin after the procedure, they note that they are painful and more disturbing than before the puncture. This means everything is going according to plan, stimulation of labor was successful. The main purpose of the puncture is completed.



Bladder puncture

What do they pierce with?

Many people are interested in what is used to pierce the bladder during childbirth and whether there is a danger to the fetus. With amniotomy, there is a risk of injuring the baby's head. The operation is performed with an instrument similar to a crochet hook. Conditions for puncture of the bladder:

• sterile instrument;
• The external genitals are treated with an antiseptic.

This hook can touch the baby's head. The wounds are not dangerous. A sanitary and hygienic regime is maintained in the maternity room; scratches will be treated and heal quickly.



Special hook

How is a puncture done?

The question of how to pierce the bladder before childbirth worries many expectant mothers. Fear of the procedure arises due to ignorance of the intricacies of the process.

The hook is inserted into the vagina with your fingers. At the moment of contraction, when the bubble is in its most tense state, the tool clings to the shell.

1. The shells of the bubble are separated through the hole that appears.
2. The hook is removed.
3. The amniotic fluid is poured out.

Their color is important to assess the baby's condition. Green colored waters are a cause for concern. This condition requires special attention and control.

Without surrounding fluid, the fetus can remain in the bladder for no more than 10-12 hours. Otherwise, negative consequences for the health and development of the baby are possible. The need to puncture the bladder to induce labor is determined by the doctor. If the procedure is completed in a timely and correct manner, undesirable consequences the baby will not be observed.

It is impossible to know in advance how long it will take for contractions to begin if the bladder is punctured. There is a possibility that additional stimulation will be required.

How long does it take for contractions to start after the bladder is punctured? It depends on the condition. expectant mother and its hormones. Almost always, disruption of the integrity of the amniotic membrane is sufficient to induce labor. Contractions start very quickly. Provided that the cervix is ​​in a state of readiness, has contracted, become soft, and dilated. If the bladder is punctured and there are no contractions or labor remains weak, additional stimulants are needed, such as oxytocin. Usually, doctors do not wait long to prevent the child from becoming infected, and prescribe medications 3 hours after the puncture.

How long does it take to give birth?

It is impossible to unequivocally answer the question of how long it takes to give birth after a bladder puncture. Usually after the procedure, childbirth occurs quickly and rapidly.

If labor is active, the baby is born within a few hours.

After an amniotomy, a machine is connected to the woman in labor to monitor the condition of the fetus. If everything is ok then emergency measures do not accept. When the procedure is performed incorrectly, additional measures may be required to speed up the process. For example, if too much water is drained, part of the baby's umbilical cord or limb may fall out.



The result of an incorrectly performed amniotomy

How long does labor last after a puncture?

The procedure directly affects the duration of labor in the case of.

Main features:

• the neck is open at least halfway, that is, 5 fingers;
• it is smooth and short.

Then the puncture will contribute to its rapid opening to the end, and therefore bring the birth closer. A few hours maximum and the baby will be born. If stimulation with hormonal drugs is required, labor will be longer.

The main thing is that the child should not be without water for more than 12 hours. This is exactly the task facing maternity hospital workers and mothers.

Conclusion

1. Having your bladder pierced before giving birth is not a dangerous procedure. It can be assumed in advance, in case of known illnesses of the woman in labor.
2. Usually the procedure is carried out to stimulate labor during weak contractions.
3. Only a qualified doctor should prescribe and perform a puncture. When performed correctly, it causes rapid labor and brings the moment of the long-awaited meeting with the baby closer.

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Approximately 7-10% of women in the maternity hospital undergo an amniotomy. Pregnant women who hear about this manipulation for the first time are frightened by it. Natural questions arise: amniotomy, what is it? Is it dangerous for the child? Not knowing why this procedure is performed, many expectant mothers are negative in advance. Information about the indications, contraindications and possible consequences of amniotomy will help you understand whether your fears are justified.

Amniotomy is an obstetric operation (translated as amnion - water membrane, tomie - dissection), the essence of which is to open the amniotic sac. The amniotic sac and the amniotic fluid filling it play important role in normal intrauterine development of a child. During pregnancy, they protect the fetus from external mechanical influences and microbes.

After opening or natural rupture of the amnion, the uterus receives a signal to expel the fetus. As a result, contractions begin and the baby is born.

The manipulation to open the amniotic sac is carried out with a special tool in the form of a hook at the moment when the bubble is most pronounced, so as not to damage soft fabrics baby's heads. Amniotomy is a completely painless operation, since there are no nerve endings on the membranes.

Types of amniotomy

Opening the amniotic sac, depending on the moment of the manipulation, is divided into four types:

• prenatal (premature) amniotomy - performed before the onset of labor for the purpose of inducing labor;
• early amniotomy – performed when the cervix is ​​dilated to 7 cm;
• timely amniotomy - the amniotic sac is opened at a cervical opening of 8-10 cm;
• belated amniotomy - opening of the amniotic sac on the birth table, when the head has already dropped to the bottom of the pelvis.

When is it needed?

Basically, an amniotomy is performed during childbirth if the fetal sac has not ruptured on its own. But there are situations in which urgent delivery is necessary. In this case, puncture of the amniotic sac is performed even in the absence of contractions. Indications for it are:

1. Post-term pregnancy. Normal pregnancy lasts up to 40 weeks, but if the period is 41 weeks or more, the question arises about the need for labor induction. During a post-term pregnancy, the placenta “grows old” and can no longer perform its functions in full. Accordingly, this affects the child - he begins to experience a lack of oxygen. In the presence of a “mature” cervix (the cervix is ​​soft, shortened, allows 1 finger), the woman’s consent and there are no indications for cesarean section this moment, perform a puncture of the bladder to induce labor. In this case, the fetal head is pressed against the entrance to the pelvis, and the volume of the uterus decreases somewhat, which contributes to the occurrence of contractions.
2. Pathological preliminary period. The pathological preliminary period is characterized by long, several days of preparatory contractions, which do not develop into normal labor and tire the woman. During this period, the child experiences intrauterine hypoxia, which resolves the issue in favor of prenatal amniotomy.
3. Rhesus conflict pregnancy. At negative rhesus blood in the mother and positive in the fetus, a conflict arises regarding the Rh factor. At the same time, antibodies accumulate in the blood of the pregnant woman, which destroy the red blood cells of the fetus. If the antibody titer increases and signs of hemolytic disease of the fetus appear, urgent delivery is necessary. In this case, the amniotic sac is also punctured without contractions.
4. Preeclampsia. This serious disease pregnant women, characterized by the occurrence of edema, the appearance of protein in the urine and increased blood pressure. In severe cases, preeclampsia and eclampsia are added. Preeclampsia negatively affects the condition of the woman and the fetus, which is an indication for amniotomy.



If labor has already begun, with certain characteristics of the expectant mother’s body, you will also have to resort to opening the fetal sac. Indications for which amniotomy is performed during childbirth:

1. Flat amniotic sac. The amount of anterior water is approximately 200 ml. A flat amniotic sac is practically the absence of anterior waters (5-6 ml), and the membranes are stretched on the baby’s head, which prevents normal labor and can lead to a slowdown and cessation of contractions.
2. Weakness of generic forces. In the case of weak, short and unproductive contractions, the dilation of the cervix and the advancement of the fetal head are suspended. Since amniotic fluid contains prostaglandins that stimulate cervical dilatation, early amniotomy is performed to enhance labor. After the procedure, the woman in labor is observed for 2 hours and, if there is no effect, the issue of birth stimulation with oxytocin is decided.
3. Low position placenta. With this position of the placenta, as a result of contractions, its detachment and bleeding may begin. After amniotomy, the fetal head is pressed against the pelvic inlet, thereby preventing bleeding.
4. Polyhydramnios. The uterus, overstretched by a large amount of water, cannot contract correctly, which leads to weakness of labor. The need for early amniotomy is also explained by the fact that its implementation reduces the risk of prolapse of umbilical cord loops or small parts fetus with spontaneous rupture of water.
5. High blood pressure. Preeclampsia, hypertension, heart and kidney diseases are accompanied by high blood pressure, which negatively affects the course of labor and the condition of the fetus. When the amniotic sac is opened, the uterus, having decreased in volume, frees nearby vessels and the pressure decreases.
6. Increased density of the amniotic sac. Sometimes the membranes are so strong that they cannot open on their own even with the cervix fully dilated. If an amniotomy is not performed, the baby may be born in the amniotic sac with water and all membranes (in the shirt), where it can suffocate. This situation can also lead to premature placental abruption and bleeding.

Are there any contraindications?

Although in many situations opening the amniotic sac facilitates the birth of a child, there are contraindications to this procedure. Amniotomy during childbirth is not performed if:

• a pregnant woman has genital herpes in the acute stage;
• the fetus is in a leg, pelvic, oblique or transverse presentation;
• the placenta is too low;
• umbilical cord loops do not allow the procedure to be performed;
• Natural childbirth is prohibited for a woman for one reason or another.

In turn, a contraindication to childbirth naturally This is due to the incorrect location of the fetus and placenta, the presence of scars on the uterus and abnormalities in the structure of the birth canal. They are also prohibited in case of severe symphysitis, heart pathologies and other diseases of the mother that pose a threat to her health and life or interfere with the normal birth process.

Technique

Although amniotomy is an operation, the presence of a surgeon and anesthesiologist is not required. The opening of the amniotic sac (puncture) is performed by an obstetrician during a vaginal examination of the woman in labor. The manipulation is absolutely painless and takes a few minutes. A puncture during pregnancy is performed with a sterile plastic instrument that resembles a hook.

The procedure consists of the following steps:

1. Before amniotomy, the woman in labor is given No-shpu or another antispasmodic drug. After its action begins, the woman should lie down on the gynecological chair.
2. Then, the doctor, wearing sterile gloves, dilates the woman's vagina and inserts the instrument. Having hooked the amniotic sac with a plastic hook, the obstetrician pulls it out until the membrane is torn. After this, an outpouring of water occurs.
3. At the end of the procedure, the woman needs to remain in a horizontal position for about half an hour. During this time, the child’s condition is monitored using special sensors.



The amniotic sac is opened outside the contraction, which ensures the safety and convenience of the procedure. If a woman is diagnosed with polyhydramnios, the water is released slowly to prevent prolapse of the umbilical cord loops or fetal limbs into the vagina.

Prerequisites

Following a number of rules allows you to avoid complications during manipulation. Mandatory conditions without which amniotomy is not performed include:

• cephalic presentation of the fetus;
• birth not earlier than 38 weeks;
• no contraindications to natural delivery;
• pregnancy with one fetus;
• readiness of the birth canal.

The most important indicator is the maturity of the cervix. To perform an amniotomy, it must correspond to 6 points on the Bishop scale - be smoothed, shortened, soft, and allow 1-2 fingers through.

Complications and consequences

When performed correctly, amniotomy is a safe procedure. But, in rare cases, childbirth after puncture of the bladder can be complicated. Among the undesirable consequences of amniotomy are:

1. Prolapse of the umbilical cord or fetal limbs into the vagina of the woman in labor.
2. Injury to the vessels of the umbilical cord during its membrane attachment, which may be accompanied by massive blood loss.
3. Deterioration of uteroplacental blood flow after manipulation.
4. Changes in fetal heart rate.

There is also a risk that opening the amniotic sac will not give the desired result and labor will not become active enough. In this case, the use of drugs that stimulate contractions or caesarean section, since a child’s prolonged stay without water threatens his life and health.

Any intervention in the body has its consequences and they are not always positive. But compliance with all conditions for amniotomy allows you to reduce the risk of complications to a minimum. Therefore, if there are indications, you should not refuse to open the amniotic sac and other necessary manipulations during childbirth.

Useful video: the need and possible consequences of amniotomy from the point of view of foreign specialists

Olga Rogozhkina

midwife

Childbirth does not always take place according to the classic version, as described in books. Sometimes amniotomy is necessary - forced opening of the amniotic sac to induce labor. The main condition for the procedure is the physiological readiness of the birth canal (maturity of the cervix) and the professionalism of the obstetrician. For whatever reason, an amniotomy is performed, there is no need to doubt its necessity, since the doctor’s task is to preserve the health of the mother and child. If the indications and requirements for manipulation are observed, the procedure does not have negative consequences.

In what cases is the amniotic sac punctured, and what could be the consequences?

What is amniotomy

In the womb, the baby is surrounded by amniotic or amniotic fluid, which is located inside a dense amniotic sac. Artificial opening of the membranes is called amniotomy. During labor, when the bladder does not rupture on its own, it is opened by an obstetrician.

What happens to the amniotic sac during childbirth

With the onset of labor, the uterus opens to allow the fetus to move along the birth canal. At the moment of maximum dilatation of the cervix, the amniotic sac ruptures and the baby comes out with the waters. This should ideally be the case, but it doesn’t always work out. Sometimes the membrane ruptures prematurely or does not break its integrity for a long time.

Indications for amniotomy

The amniotic sac is artificially opened for the following reasons:

• Severe form of gestosis.
• All deadlines for the onset of labor have passed.
• Premature placental abruption.
• Freezing of the fetus later gestation.
• Exacerbation of severe chronic diseases in a pregnant woman.
• Prolonged labor.
• The presence of Rh conflict between the mother and the unborn child.
• The uterus opened, but the bladder did not burst on its own.
• Weak contractions during childbirth.
• Incorrect location of the placenta (low).
• Excessive amount of amniotic fluid.
• Insufficient amount of amniotic fluid inside the bladder.
• The presence of two or more embryos.
• A sharp increase in blood pressure in a woman in labor.
Sometimes the amniotic sac is opened to speed up labor when the uterus is dilated at least 5 cm.

How is amniotomy performed?

Typically, the opening of the amniotic sac is carried out according to the following scheme:
• The expectant mother is given an injection of an antispasmodic, for example, Papaverine or another similar drug.
• The woman is placed on a special gynecological chair.
• The doctor inserts an instrument that looks like a hook.
• After the integrity of the fetal bladder is broken, the woman is observed for about 30 minutes, listening to the heartbeat of the unborn child.
The main thing when performing an amniotomy is that the hole in the amniotic sac is small and the fluid flows out gradually, otherwise the umbilical cord or the baby’s limbs may come out along with the water.

Risks and consequences of puncturing the amniotic sac

If the procedure is carried out correctly, the risks are reduced to zero, but sometimes complications are possible in the form of:
• Infections.
• Disturbances in labor - too fast or too slow.
• Deterioration of the baby's condition.
• Loss of the umbilical cord or some parts of the baby.
• Heavy bleeding.
Such violations occur extremely rarely and are rather the exception.

Does the woman feel pain during the procedure?

Since the amniotic sac is not closely connected to the woman’s body and has no nerve endings, there is no pain from a violation of its integrity. All that a woman feels is the leakage of fluid and the beginning of labor.

Scratches in a child after puncture of the amniotic sac

If the procedure is carried out according to all the rules, amniotomy cannot harm the child, but there are cases when scratches remain on the baby’s head. This happens when:
• Too little amniotic fluid.
• The baby's head is very close to the exit and when piercing the bubble, the instrument may touch it.
• The water broke earlier, but the doctor did not pay attention.

In general, amniotomy is not a dangerous procedure and is widely used these days to speed up labor, even when there is no particular need for it. However, if there are wounds or scratches on the child’s body, consult a doctor for explanations and advice.

In utero, the child is protected by a special membrane - the amnion, filled with amniotic fluid. They protect it from shock when moving, and the shell prevents the upward penetration of infection from the vagina.

During childbirth, the baby's head is pressed against the cervix and a fetal bladder is formed, which, like a hydraulic wedge, gradually stretches the cervix and forms the birth canal. Only after this does it break on its own. But there are situations when the bladder is punctured before childbirth without contractions.

This procedure is not prescribed at the request of the woman or the whim of the doctor. Successful amniotomy is possible if certain conditions are met:

• the fetal head is presented;
• full-term pregnancy of at least 38 weeks with one fetus;
• estimated fetal weight more than 3000 g;
• signs of a mature cervix;
• normal pelvic size;
• There are no contraindications for natural childbirth.

Types of amniotomy

The moment of the puncture determines the type of procedure:

1. Prenatal - is carried out before the onset of contractions, its purpose is to induce labor.
2. Early - before the cervix is ​​dilated by 6-7 cm, it can speed up this process.
3. Timely - performed during effective contractions, the opening of the cervix is ​​8-10 cm.
4. Belated - in modern conditions rarely performed, performed at the time of expulsion of the fetus. Amniotomy is needed to prevent bleeding in the woman in labor or hypoxia in the child.

How is childbirth after a bladder puncture? The process of the birth of a child in this case does not differ from the natural one. In any case, the condition of the fetus is monitored using a CTG machine.

Indications for bladder puncture during childbirth

Bladder puncture stimulates planned labor or is performed during it.

Labor induction using amniotomy is indicated in the following cases:

• gestosis, when indications for urgent delivery appear;
• premature placental abruption;
• fetal death in utero;
• post-term pregnancy;
• severe chronic diseases of the cardiovascular system, lungs, kidneys, for which delivery is indicated from 38 weeks;
• Rh conflict between mother and child;
• pathological preliminary period.

The latter condition is the occurrence of small contractions over several days, which do not develop into normal labor. This causes intrauterine suffering of the fetus from lack of oxygen and fatigue of the woman.

How long will it take for labor to begin after the bladder is punctured? The onset of labor is expected no later than 12 hours later. Although nowadays doctors do not allow that much time for waiting. Prolonged stay of a child in a waterless environment increases the risk of infection. Therefore, 3 hours after opening the amnion, if contractions have not begun, stimulation with medications is used.

When labor has already developed, the puncture is performed according to the following indications:

1. The cervix dilated 6-8 cm, but the water did not break. Their further preservation is impractical; the bubble no longer fulfills its function.
2. Weakness of labor. Puncture of the bladder in most cases leads to its activation. After amniotomy, wait 2 hours; if there is no improvement, then resort to stimulation with oxytocin.
3. Polyhydramnios overstretches the uterus and prevents normal contractions from developing.
4. With oligohydramnios, a flat amniotic sac is observed. It covers the baby's head and does not function during childbirth.
5. A low-attached placenta may begin to separate as contractions develop. And opening the amnion will allow the fetal head to press tightly against the lower segment of the uterus and contain abruption.
6. In case of multiple pregnancy, the bladder of the second child is punctured 10-15 minutes after the appearance of the first.
7. High blood pressure decreases after autopsy.

Technique for puncturing a mother's bladder



• 30 minutes before inducing labor, the woman is given the antispasmodic Drotaverine by puncture of the bladder.
• Later, an examination is carried out on the obstetric chair; the doctor evaluates the cervix and the location of the head.
• With a sliding movement of your fingers, a special jaw - a hook - is inserted into the vagina.
• With its help, the membrane clings during contractions, and the gynecologist inserts a finger into the resulting hole. The tool is removed.
• Holding the fetal head through the abdomen with the other hand, the membranes are carefully separated and the anterior amniotic fluid is released.

They are collected in a tray and their condition is visually assessed. Green colored water with meconium flakes indicates intrauterine hypoxia fetus This condition deserves additional attention. The pediatric service is notified in advance of the child’s possible condition.

If a large volume of water is drained at once, this can lead to the loss of umbilical cord loops or small parts of the fetal body.

After the procedure, the mother in labor is connected to a CTG machine for 30 minutes to assess the baby’s condition.



Is it painful or not to puncture the bladder before giving birth? The shells are not penetrated nerve endings, so the procedure is absolutely painless.

However, complications sometimes develop:

• traumatization of the umbilical cord vessel if it was attached to the membrane;
• loss of umbilical cord loops or parts of the fetal body (arms, legs);
• deterioration of the fetus;
• rapid labor activity;
• secondary birth weakness;
• child infection.

How long does labor last after bladder puncture? The duration depends on their parity or quantity:

• In primigravidas, the normal duration of labor is 7-14 hours.
• Multiparous women require less time - from 5 to 12.

Contraindications for bladder puncture in a pregnant woman



Despite the simplicity of the procedure and the small number of complications of the manipulation, there are serious contraindications for its implementation. Most of them coincide with contraindications for natural childbirth:

1. Herpetic rashes on the perineum will lead to infection of the child.
2. Pelvic, leg, transverse or oblique presentation of the fetus, umbilical cord loops in the head area.
3. Complete placenta previa. Childbirth in this case is impossible - the placenta is attached above internal throat and prevents the lower segment of the uterus from unfolding.
4. Failure of the scar on the body of the uterus after cesarean section or other surgical interventions.
5. Narrowing of the pelvis 2-4 degrees, bone deformities, tumor processes in the pelvis.
6. The weight of the fetus is more than 4500 g.
7. Rough scars causing deformation of the cervix or vagina.
8. Triplets, conjoined twins, breech presentation the first child of twins.
9. High myopia.
10. Delayed fetal development 3rd degree.
11. Acute fetal hypoxia.

In the absence of the listed contraindications, amniotomy is a safe procedure and does not affect the condition of the fetus.

Yulia Shevchenko, obstetrician-gynecologist, especially for the site

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