Artificial Rupture of Membranes (Amniotomy)

Overview

• Definition: Procedure to induce labor and check for meconium in amniotic fluid.
• Timing: Usually performed during active phase of the first stage of labor.
• Location: Should be done in the labor room, not in the antenatal ward.

Procedure Preparation

• Positioning: Mother should be in dorsal position.
• Aseptic Technique: The person performing the procedure should scrub and wear a gown, as this is a strict aseptic procedure.

Steps of the Procedure

1. Explain to the Mother: Inform the patient about the procedure beforehand.
2. Clean Area: Use five antiseptic swabs to clean the vulva.
3. Vaginal Examination:
   • Assess cervical dilatation and effacement.
   • Exclude cord presentation.
   • Identify the presenting part to check position and level.
   • Feel for membranes.
4. Cervical Dilatation: Amniotomy is typically performed when cervical dilatation is about 5-6 cm, provided conditions are satisfactory.
5. Performing Amniotomy:
   • Keep fingers on the fetal head.
   • Use blunt long artery forceps along the fingers until it meets the fetal head.
   • Do not open the forceps until it reaches the fetal head.
   • Grab the membranes and pull.
   • If ruptured, normal amniotic fluid (milk color) will come out.
   • Drain the fluid slowly while keeping fingers intact to prevent cord prolapse.

Post-Procedure Care

• Auscultation: Check fetal heart sounds after amniotomy.
• CTG Monitoring: Run a cardiotocograph to assess fetal well-being.

Important Considerations

• Delays: Amniotomy should be delayed if presenting part is breech or in high head presentation.

Risks of Amniotomy

• Cord prolapse
• Sepsis
• Tissue trauma
• Placental abruption

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These notes provide a structured overview of the amniotomy procedure, including preparation, execution, post-care, considerations, and potential risks.