Amniotomy During Labor – Why is it Performed, Risks and Complications

What is Meant By Amniotomy?

Amniotomy is generally known as rupturing of the amniotic sac artificially. The amniotic sac is filled with fluid that protects the baby from surroundings and mechanical injuries. The amniotic sac breaks down before the onset of labor and delivery and the fluid gushes out from the vagina.

When the amniotic sac breaks down, it releases hormones that intensify muscle contractions. The process is commonly performed to expedite labor with the help of fetal scalp electrodes or uterine pressure catheters. This is commonly done inside the labor room at the bedside. It’s a less risky procedure to induce labor and deliver the baby faster.

When is Amniotomy Performed?

An amniotomy procedure or artificial membrane rupture is usually done when the cervix is partially dilated or takes longer for dilation. This process is helpful to increase contraction and induce labor faster.

If the fetus is in vertex position with its head down in the pelvic region, amniotomy is useful to avoid the umbilical cord slipping below the baby’s head during delivery. In some cases, fetal monitoring combines an amniotomy procedure to detect meconium staining (fetal distress).

[Read : Electronic Fetal Monitoring During Labor and Delivery]

Why is Amniotomy Performed During Labor?

An amniotomy is often performed to speed up the labor process. However, it may or may not be appropriate for everyone.

Here are some potential reasons why amniotomy is performed by doctors

1. Induce Labor

Rupturing of the amniotic sac through amniotomy releases a hormone that causes wild muscle contractions. The baby may move deep into the pelvis region without an amniotic fluid cushion. The pressure causes cervix dilation to deliver the baby.

[Read : What Happens To Your Cervix During Labor Or Birth?]

2. To Monitor Baby

Doctors also perform amniotomy to monitor fetal properly and check the heart rate. The monitor will be placed on the baby’s head for an accurate reading.

3. Amniotic Fluid Examination

Passing excessive meconium (the first poop of a baby) can affect the baby’s health. Amniotomy fluid is also performed to check meconium in amniotic fluid. This helps healthcare experts plan to suction the baby’s nose and mouth after delivery.

How to Prepare For Amniotomy During Labor?

Before physicians start amniotomy, they will prepare women for it. Doctors explain the entire procedure, such as alternative options and risks associated with amniotomy.

• Obtain the consent form
• Physical examination for any condition that may interrupt or oppose amniotomy
• Put soaking or under pads to soak all amniotic fluid
• Perform a vaginal examination and track the fetal heart rate
• Monitor characteristics of amniotic fluid

The Procedure of Amniotomy During Labor

Once doctors are prepared for an amniotomy, the healthcare provider will conduct cervix exams to determine if it is dilated, thinned, or softened. Suppose the baby’s head is accurately positioned or pressed against the pelvis or cervix. In that case

• Your healthcare provider will place soaking towels under the vagina to absorb excessive fluids once they rupture the amniotic sac.
• A thin tool such as an amnihook is used to rupture the membrane, similar to the hook you might have used to crochet a quilt.
• The amnihook is inserted inside the uterus through the vagina.
• Doctors scratch the amniotic fluid sac to rupture the membrane when they find it.

Risks and Complications of Amniotomy During Labor

There is some vital risk or complications associated with amniotomy. 

Here are a few complications of performing an amniotomy during labor.

1. Prolapse of Umbilical Cord

During amniotomy, the umbilical cord may prolapse. It happens when the umbilical cord drops from the vagina before baby delivery. This may cut off the oxygen supply to the baby.

2. Infection

Once amniotic fluid comes out, the baby doesn’t have any kind of protection further. There will be a greater risk of infection if delivery time expands after a water break.

3. Increases Pain

Many women feel intense contractions after the procedure. This may increase pain sensation after the rupturing of the amniotic sac. No cushion between the cervix and head results in excessive pain.

4. Cesarean Delivery

You may be at greater risk of cesarean delivery. Because, once the membranes are ruptured, the risk of fetal heart rate abnormalities increases leading to emergency C-Sections. 

[Read : Emergency C-Sections]

What to Expect After Amniotomy During Labor?

After amniotomy, women may feel warm water flowing out of the vagina. It might be a quick rush of a water trickle. You may feel slight discomfort and experience menstrual-like cramps in the pelvis and lower back if membrane rupturing induces labor quickly. Doctors will continually monitor your condition to notice any signs of complications.

When Amniotomy Should Not Be Performed?

Your gynecologist will consider so many factors before heading to performing an amniotomy. They may not consider performing an amniotomy if

• Your baby’s head still has not descended inside the pelvis region
• Your baby’s head doesn’t come first inside the birth canal, meaning the fetal station is not favorable.
• Your cervix doesn’t favor amniotomy. The favorable condition is when the cervix starts dilating, thin, soft, and open.
• You may have vasa previa (a condition when blood vessels start crossing over the cervix). This can be life-threatening for babies.

Amniotomy is a good process to speed up the labor process during delivery. But keep in mind each pregnancy is different. There’s no evidence yet whether amniotomy works effectively in all cases. The procedure can be dangerous if you already have some medical history. Make sure to get a doctor’s consultation and understand the risk and significance of artificially breaking the membrane. Getting information helps to achieve healthy and safe delivery.

FAQ’s

1. How Long Does it Take From Amniotomy to Delivery?

After the amniotomy procedure, the birthing process will happen within 24 hours. If it takes longer, there’s a risk of intrauterine infection. This may cause harm to the fetus, and doctors may suggest some antibiotics treatment.

2. Does Amniotomy Induce Labor?

Amniotomy is a simple membrane rupturing procedure to release amniotic fluid from the sac to induce labor. If the cervix is dilated completely, there is no need to do any intervention to induce labor.

3. Does the Breaking of Water Increase the Labor Process?

Foremost, let it be clear that breaking the amniotic sac membrane may or may not speed up the labor process. Sometimes, the procedure may not affect or shorten the labor length. It is advised to seek healthcare expert advice for a better understanding of your condition and the necessity for an amniotomy.

Read Also: Low Amniotic Fluid (Oligohydramnios) During Pregnancy