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Amniotomy (puncture of the fetal bladder)

Many pregnant women are afraid of an amniotomy. This fear is mainly due to a lack of knowledge about this procedure. In fact, an amniotomy is a standard medical procedure that is performed in the delivery room without the presence of anesthesiologists.

What is an amniotomy?

In the womb, the fetus is located in the amniotic sac, a shell that is filled with a liquid called amniotic fluid. During childbirth, the amniotic sac promotes the opening of the uterus, which is necessary for the birth of a child.

Amniotomy is an artificial opening of the fetal bladder.

How is an amniotomy performed?

Everything takes place on an outpatient basis. A woman does not need to prepare for the procedure in advance. An obstetrician-gynecologist performs an amniotomy without the participation of a surgeon and an anesthesiologist. The woman does not experience pain during or after the procedure. This is due to the fact that the membrane being opened is devoid of pain receptors.

The doctor opens the bladder with a special disposable instrument – an amniotome. With further dilution of the membranes, amniotic fluid is released. And in some cases, to determine the amount of remaining water, manipulation can be performed under the supervision of ultrasound.

Usually 5-10 minutes after the end of the amniotomy, a woman can move independently.

Indications for amniotomy

Amniotomy at the EMC clinicAlthough the procedure is simple, it is carried out only according to indications.:

  • Weak labor activity. In this case, the procedure is performed to enhance contractions and the early onset of labor. If the uterus is well prepared for labor, labor usually comes within a few hours after the amniotomy.

  • The flat shape of the fetal bladder. With such a problem, there is a poor water content, which leads to a delay in labor and a lack of contractions.

  • A very dense shell. In this case, self-opening of the bubble is impossible. The birth of a baby in a bubble is extremely dangerous: due to lack of oxygen, the child may suffocate.

  • Delayed pregnancy. After 41 weeks of pregnancy, the baby begins oxygen starvation. Therefore, as in the case of weak labor, the procedure is performed for the early onset of labor.

  • Polyhydramnios. A large amount of water stretches the uterus. This leads to a complication of labor.

  • Rhesus conflict. This problem can lead to fetal death. To save the baby, doctors can call an emergency delivery.

  • Toxicosis. Prolonged toxicosis, up to the 3rd trimester, leads to an increase in a woman's blood pressure, an increased protein content in the tests, and edema. These factors complicate pregnancy and threaten not only the health of the pregnant woman, but also the baby.

  • Low-lying placenta.

Contraindications to amniotomy

  • Presentation of the umbilical cord.

  • Incorrect presentation of the fetus.

  • The disproportionate size of the fetus to the size of the pelvis of the pregnant woman.

  • Multiple pregnancies.

  • Placental presentation.

Risks of amniotomy

The risks are practically reduced to zero. If cases of fetal infection were often recorded many decades ago, now it is very rare, since amniotomy is performed in sterile conditions using disposable equipment. It is extremely rare for bleeding to begin – in such cases, specialists decide on the implementation of CS.

Doctors do not perform an amniotomy if a woman is fundamentally opposed to this procedure. This usually happens if the pregnant woman does not know enough about the procedure and thinks that it will entail serious consequences. The main task of the doctor in this matter is to explain in detail why it is very important to perform an amniotomy in a particular situation and how it can be dangerous to refuse it. Only after detailed explanations should a woman make a decision.

Since the procedure is performed manually, the results largely depend on the doctor. Therefore, you only need to contact specialized clinics where doctors with extensive experience in amniotomy, complicated pregnancy and childbirth work.

Types of amniotomy

  • Prenatal amniotomy. It is performed to accelerate the onset of labor when the due date has come, but labor has not begun. 

  • Early amniotomy. It is usually performed during childbirth, with a dense bladder shell or incomplete opening of the cervix (up to 4-5 cm).

  • Timely opening of the bubble. It is performed during childbirth, with the opening of the cervix by 6-9 cm. to accelerate the full opening of the uterus.

  • A delayed process. Such an amniotomy is performed in the second period of labor if the bladder has burst on its own and there is a possibility that the baby will be born in a shell.

Advantages of contacting the EMC

  • Specialists EMC Maternity hospital trained in the best European clinics.

  • Doctors specialize in managing complex pregnancies and various cases of complicated labor.

  • The latest operating and intensive care equipment.

  • Department of Neonatology.

  • Constant monitoring of patients by medical staff.

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Questions and answers

Dermoid cyst and pregnancy
An ultrasound revealed a mass in my left ovary during the first pregnancy. I was told that it is a dermoid cyst. Five years have passed since then. I gave birth to a second child. An ultrasound was performed annually. There were differences in size, but not significant. Since I’m going to have the 3rd child, another
ultrasound was done today. The doctor said that the cyst had increased. I am concerned about it. Don't know where to start. What tests are needed? Thank you.
...more
Surgical treatment is strictly indicated in your case given the long history of the mass in the ovary and its rapid growth in recent times. In our clinic, we perform such an intervention laparoscopically through 3 small punctures. Patients go home next morning after the surgery and may return to work after 3 days.
This surgery must be as delicate to preserve healthy ovarian tissue (considering your reproductive plans) as radical at the same time to remove the mass together with the capsule. At the preoperative stage an expert level ultrasound with Doppler is required, as well as blood tests for Ca-125 and НЕ-4 tumor markers. The decision concerning the necessity of FEGDS and colonoscopy is taken based on the results of these tests.
...more
Total knee replacement
My mom suffers from gonarthrosis for the past three years. Despite treatment by injections the pain is still present. MRI revealed a meniscal tear in the posterior horn, the presence of small bony osteophytes on the patella, a small amount of fluid in the joint cavity (signs of exudative synovitis were detected)
joint space is asymmetrically narrowed in the medial segment. The pain is ongoing but the knee remains flexible. Tell me, please, whether the surgery is contraindicated for meniscal tear in case of arthrosis? Is it possible to do an arthroscopic surgery on the meniscus in our case or it should be «major» surgery? And what would you advice concerning knee replacement for the patient in the age of 57? What is the life time of the artificial joint?
...more
It is necessary to make an X-ray of the knee in direct projection in standing position. If it turns out that there is no medial cartilage in the medial area, then the knee replacement is the only solution. The age of 57 is normal for the prosthetics. Modern artificial knee joint (when properly placed of course) will
serve for a lifetime. You can make an appointment via phone +7 (495) 933-66-44.
...more
Kardanov Andrey
07 September 2016
Pain
I am 19 years old, professionally engaged in weightlifting. I did an arthroscopy of both knee joint a year ago, now feel pain in them and it prevents me from training at full capacity. I visited a traumatologist, and «osteoarthritis of 1 degree» was diagnosed. Could you advise me some medicines or anything else to
relief the pain? Thank you very much for the answer!
...more
First of all you should undergo an MRI and find out what was done at arthroscopy; if it’s really an arthrosis of 1 degree, hyaluronic acid injections are possible and physiotherapy is not required. Anyway, you are always welcome to consultation for thorough examination.
Question to Dr. Yakobashvili
Tell me, please, at which age child's hearing should be checked-up if we were informed at the hospital before discharge that one ear does not hear. At the moment the child’s age is 1.5 months. Thank you.
These tests done in the hospital are often false negative. Hearing can be tested now, it is necessary to make an appointment to the audiologist.
Cought
A child of 11 years old, suffers from cough for more than six months. The cough is dry, sometimes attack-like, mainly begins during the day, and often occurs before sleep. There is no cough at night. CBC is normal, glucose is 4.16, total IgE 111.80, Toxocara, Ascaride are negative, Cytomegalovirus, Mycoplasma are
negative, PPD test is negative as well. A chest x-ray is normal. We have already consulted with a therapist, otolaryngologist, pulmonologist, neurologist, gastroenterologist... the cough is still present. What should we do?
...more
First of all, there are no results of whooping cough testing among the results provided above. The disease cannot be ruled out, even if your child was vaccinated. The blood test for antibodies against the whooping cough germ is required (blood test for class M and G antibodies against Bordetella pertussis). Second,
even a slight increase in class E antibodies is a reason to visit an allergist and to perform an evaluation of respiratory function with bronchodilator. This method will detect a latent bronchial spasm in your child. Even if the results of the test will be normal, allergologist mast rule out the allergic nature of the cough even if it's not obstructive syndrome. Third, this cough can be due to gastroesophageal reflux. It is difficult to draw any conclusions having no data of gastroenterologist’s consultation. 24-hour acidity monitoring of the stomach and esophagus is carried out to confirm or exclude the presence of reflux. Fourth, you didn’t mention whether x-ray of nasopharynx and paranasal sinuses was done. Perhaps, after all, the pathology is associated with ENT organs.
...more

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