4 hours after puncturing the bladder, there are no contractions. The question of amniotomy: the pros and cons of bladder puncture

The waiting period for the baby is the most wonderful in the life of every woman. The expectant mother is looking forward to the first meeting with her blood, because she wants so much to squeeze this little lump to herself as quickly as possible, to look at it.

But, despite all the charm, there are not very pleasant sensations that can accompany this period. A young mother will face various problems face to face. There are cases that, for one reason or another, the contractions do not start and the doctors for the normal birth of the baby must call them out with their own hands.

One of the most common options to induce labor is to puncture the amniotic fluid. There is no need to be afraid of this procedure, since it is done for the good of the child and will not harm him in any way.

Puncture without contractions

Very often, opening the organ in question in pregnant women causes great excitement, since few people know how this manipulation is performed. The first step is to figure out in which cases this procedure is mandatory, and when it is impossible to do without it. In any case, a woman should be aware of the fact that if the doctor told her about the need for a bladder puncture, then you should not refuse.

Often the bubble needs to be punctured, because there is a certain threat to the life of the baby. The manipulation is carried out for various reasons, on the most common there is a threat and. Also, the bladder is pierced if a woman has a disease such as diabetes mellitus, hypertension, impaired kidney function.

Very often, doctors are forced to provoke childbirth in this way with intrauterine death of a baby, with a pregnancy that is postponed, with.

It also happens that contractions do not appear regularly. In this case, the woman in labor cannot give birth on her own. The opening of the uterine cervix is \u200b\u200bgreatly slowed down, and the baby cannot come out normally. And in the amniotic fluid there are prostaglandins, which greatly enhance labor activity. Therefore, they decide to conduct an amniotomy. If the expected effect of such manipulation did not work out, then the woman in labor is injected with special drugs that activate.

Women want to know how this procedure is performed. As noted earlier, there is no need to worry about a bladder puncture. Initially, the maternity hospital workers treat the female genitals with antiseptic agents, additionally give her a drink with an analgesic effect.

After a while, after the pain reliever has worked, the doctor expands the lumen of the vagina and slowly inserts the hook. With this special tool, the bubble is captured and gently pulled towards itself until the walls of the bubble burst. Further, the expectant mother is observed for 30 minutes. If everything was done correctly, then the contractions are not long in coming - they begin almost immediately.

This is an absolutely safe procedure. Complications are rare. Manipulation is carried out only when necessary, only with the permission of the woman in labor. The doctor must advise the potential consequences.

This can be fetal hypoxia, infection inside the womb (occurs very rarely), bleeding, weak heartbeat in a baby, loss of umbilical cord loops. And the most important thing is that after the bladder is opened, no more than 20 hours should pass until the birth begins. The kid cannot be without water for a long time, it is dangerous for his life.

Does it hurt to pierce the bubble?

The bladder bursts without pain, because there are no nerve receptors in the fruit membrane. This procedure does not last long - a few minutes. However, in almost all cases, the fear of a woman in labor turns out to be higher than the doctors' explanations, and a spasm of the vaginal muscles occurs. At this time, the woman should take one position and not move so that the doctor does not cause any internal damage.

If you properly adjust yourself and relax completely during the procedure, then there will be no pain, even the smallest. The only thing that a woman can feel is the flow of water from the vagina.

As indicated earlier, the bladder is pierced only in case of great need, and if the doctor told the patient that such a procedure needs to be done, then she should not refuse it.

Baby scratches after amniotomy

Many wives are alarmed when they see scratches on the head of their little cub. Yes, it really happens sometimes. If a bladder puncture was used for childbirth, then the baby may be born with scratches that remained on the head from a special hook for a bladder puncture.

Of course, such a sight is not pleasant. But you shouldn't worry - it's not dangerous at all. Abrasions in the sterile conditions of the hospital quickly healed.

Usually, such traces remain during the amniotomy with. Indeed, it is in this state that the membranes are on the baby's head.

The need to puncture the amniotic bladder before childbirth is needed only by 10% of all women in labor. However, many, not understanding the specifics of such a procedure, are afraid of the painful puncture. Is it painful to pierce the bladder before childbirth, and why such a procedure may be necessary?

A bladder puncture during childbirth is carried out to stimulate labor in the absence of contractions or with them. How long does labor last after a bladder puncture, and how does labor actually proceed, does it differ from normal labor without additional stimulation?

Pierce the bladder before childbirth without contractions in the event that the pregnancy is delayed. So, today, an amniotomy (or puncture of the amniotic bladder) is performed for pregnant women if the pregnancy is more than 41 weeks, and labor activity is not observed.

After opening the bladder, contractions may begin in 60% of women in labor, the rest are given additional injections of oxytocin to start labor. Such methods are called stimulation, it is carried out only according to the testimony of a doctor, with constant monitoring of the child's condition.

Many pregnant women are interested in the question of how quickly a child is born with such a procedure, and how much differs from planned natural births with stimulation? When the bladder bursts, the uterus naturally (in the presence of oxytocin) begins to contract. There is not much difference between stimulated labor and natural labor. However, before performing such a procedure, the doctor must:

• examine the birth canal at the time of readiness;
• establish the degree of opening of the cervix (so, if there are no contractions, the period is 41+, and the cervix is \u200b\u200bworn out, soft and elastic, a puncture can be performed, if the uterus is rigid and the birth canal is not ready for childbirth, a puncture is not recommended);
• inform the woman in labor that stimulation will be carried out.

Why is it called labor, and why is a bladder puncture needed? In most cases, amniotomy is performed for those pregnant women who either are already experiencing contractions, and the degree of cervical dilatation is more than 6 cm, or those who "delay" the onset of labor.

Oversight of the child negatively affects his health:

• oxygen deficiency of the fetus may develop;
• the bones of the skull begin to harden after 42 weeks, which creates the risk of cerebral palsy during childbirth;
• the child lacks nutrients, since the placenta has depleted its reserves by this time;
• amniotic fluid accumulates a large amount of harmful substances.

It is for such understandable reasons that women in labor with pregnancy for more than 40 weeks are recommended to be hospitalized, observe the first 5-7 days, prepare the cervix, and then pierce the bladder for 42 weeks in the absence of labor.

Puncture of the amniotic fluid main indications

For amnotomy (manipulation to puncture the bladder with water), clear indications are necessary for obvious reasons. So, doctors may consider the need for a puncture in the following cases:

• overmaturity of the child 41 weeks +;
• probable fetal hypoxia (lack of oxygen);
• complication of pregnancy (prenatal amnotomy);
• when the uterus is opened by 8-10 cm (timely);
• opening of the uterus up to 5 cm with weak contractions (premature).

Bladder puncture during childbirth, why and how a puncture is made

Why pierce the bladder before childbirth and can such a fate be avoided? Many pregnant women are simply afraid for the baby's health, because the puncture is carried out directly in the vicinity of the baby's head. In fact, a bladder puncture does not pose any danger, does not bring painful sensations.

The thing is that the bubble with amniotic fluid, in which the baby floats freely for the first months, does not have nerve endings. That is why the procedure is absolutely painless. A puncture is performed when the woman in labor is located in the gynecological examination chair, with the legs raised and apart on the sides.

Mummies' fears about the danger of access to the child are in vain: the gynecologist precisely sets the place for the puncture, and the baby's head is much higher than the cervix, the pressure is not yet felt. Therefore, such a procedure does not pose any danger to the child and mother.

Opening of the amniotic fluid is required only in two cases.

Actually, there can be a large number of reasons, as already indicated earlier, but the most important reason why amnotomy is needed is:

• stimulation of labor in the later stages without contractions, but in the presence of a worn cervix;
• a puncture during the opening of the uterus by all 10 cm, when it is already possible to carry out attempts for childbirth, and the fetal bladder has not burst.

The main requirement for the beginning of the manipulation is the readiness of the birth canal, the worn out cervix.

How is a puncture of the fetal bladder performed

How and with what do they pierce the bladder during childbirth, how dangerous is it? After manipulating the cervix (the gynecologist stretches it with his fingers), a metal gynecological instrument is inserted into the vagina, which has a slightly bent end. This end engages the fetal bladder and pulls it over itself with a sharp movement. At this moment, the fetal bladder bursts, water flows out, the uterus begins to contract.

After a bladder puncture before childbirth, the baby's heartbeat is monitored (the woman in labor is connected to the CT or periodically monitored) throughout all stages of labor. The puncture is performed only by a doctor, not an obstetrician, who will continue the delivery. Such a procedure does not pose a danger to the child and mother. On the contrary, stimulation of labor activity accelerates the intensity of contractions, the baby is born faster.

What does a woman feel when the amniotic fluid is punctured

What does the woman in labor herself feel during this operation? How does it feel when piercing a bubble? Women in labor who have experienced amnotomy say that painful sensations are not present throughout the operation. Moreover, the most painful thing is the stretching of the cervix with fingers, which is mandatory by a doctor.

After puncturing the bladder, the woman will feel the outflow of fluid. The doctor pre-sets the basin at the bottom of the obstetric chair, roughly calculating the amount of fluid. In this case, the water should be light, translucent or transparent in color, without admixtures of blood, mucus and putrid smell. There may be small splashes of white flakes, which are considered normal.

After the puncture, the woman is advised to walk more in order to enhance labor. If necessary, oxytocin is administered intravenously (droppers), which enhances the effect. Further, with the contraction of the uterus, oxytocin and endorphin are produced naturally, childbirth takes place in a normal rhythm, no different from non-stimulated contractions.

From women giving birth, you can hear about such a concept as a puncture of the bladder before childbirth without contractions. This procedure is called an amniotomy. Usually about 7-10% of women in childbirth encounter it. Many pregnant women are frightened when they hear about an amniotomy. Having no idea about the correctness and necessity of this procedure, women set themselves up negatively.

What happens if the fetal bladder ruptures before contractions?

In some cases, childbirth begins with the outpouring of water. Moreover, it can be complete or partial. According to statistics, such a deviation can occur in 12% of all women. This process is called

Women immediately notice this phenomenon, especially if it happens with a large amount of water.

The amniotic fluid should be light or pink and odorless. If black, brown or green is mixed with it, then this means that there is a newborn's feces in the waters. This suggests that the fetus is undergoing oxygen deprivation, which requires rapid delivery. An admixture of yellow color can mean the presence of a Rh conflict, which also requires quick action.

When the water goes away at home, the woman in labor needs to urgently go to the hospital. In the hospital, a woman must accurately report the time of their departure.

If the body is completely ready for the birth of a child, contractions begin immediately or some time after the passage of water.

What is an amniotomy?

Amniotomy is an operation in which the amniotic sac is opened. In utero, the fetus is protected by a special membrane - the amnion, which is filled with amniotic fluid. It protects the baby from blows and infection from the vagina.

If an autopsy or rupture occurs naturally, then the uterus begins the process of erasure. As a result, contractions develop and a child is born.

The operation to puncture the bladder before childbirth without contractions is carried out with a special device in the form of a hook at the moment of its greatest severity so as not to affect the soft tissues of the baby's head.

Amniotomy types

The bladder puncture before childbirth can be divided into several types, depending on the time of the operation:

• Prenatal. It is carried out before the onset of contractions in order to induce labor.
• Early. Done if the opening of the cervix is \u200b\u200bup to 7 cm.
• Timely. If the neck is open to 8-10 cm.
• Belated. Can be carried out at the time of expulsion of the fetus. The procedure is used to prevent fetal hypoxia or bleeding in women in labor.

The process of childbirth does not change at all and corresponds to the natural one. The condition of the fetus is necessarily recorded using the KGT apparatus.

When is an amniotomy necessary?

Labor is stimulated by piercing the bladder in case of situations when an emergency delivery is needed. The procedure can be carried out in the absence of contractions:

• Postterm pregnancy. A normal pregnancy lasts 40 weeks, if it is longer, then the question of the need for obstetric aid is raised. The placenta in this situation is aging and cannot perform its functions. As a result, the child suffers, experiencing oxygen starvation.
• Gestosis. This disease is characterized by edema, high blood pressure, and the presence of protein in the urine. Gestosis negatively affects the health of the mother and fetus, therefore, an amniotomy is needed.
• Rhesus conflict. Such a pregnancy is considered difficult, so this operation helps to stimulate labor.

If labor has begun, then surgery is resorted to in the following cases:

• If the contractions do not intensify, but they weaken, the cervix slows down the process of childbirth, and so that they do not stop, the bladder is punctured. The woman in labor is monitored for 2 hours, if there is no positive dynamics, then a decision is made to resort to "Oxytocin".
• Polyhydramnios. The presence of a large amount of amniotic fluid leads to the fact that the uterus cannot naturally contract.
• High blood pressure. Diseases of the kidneys and heart, gestosis contribute to an increase in blood pressure, which negatively affects the process of childbirth and the condition of the fetus.
• Flat fetal bladder. In this situation, the anterior waters are almost completely absent, which makes labor activity difficult, and its termination may occur.
• Low location of the placenta. This position of the placenta can lead to its detachment and bleeding.

In some cases, there are contraindications for this procedure.

Are there any contraindications?

Puncture of the bladder before childbirth helps to facilitate the process of giving birth, but in some cases there are some limitations of the procedure. An amniotomy is not performed if:

• a pregnant woman has herpes on the genitals in the acute stage;
• the placenta is low;
• umbilical cord loops impede surgery;
• natural childbirth is not recommended;
• finding the fetus in an oblique, transverse and breech presentation.

The procedure for diseases of the mother's heart, with the existence of scars on the cervix and other pathologies is prohibited.

How is the bladder punctured?

Why and how is the bladder punctured before childbirth? Amniotomy is equivalent to surgery, but the presence of an anesthesiologist and surgeon is optional. After a vaginal examination, the doctor will open the bladder. The procedure includes several stages:

• Before the operation, the woman takes No-Shpu or another antispasmodic. After exposure to the drug, the woman lies down on the gynecological chair.
• Then the specialist, wearing gloves, inserts the instrument into the vagina. The amniotic fluid is hooked and pulled by the doctor until it ruptures. After that, the amniotic fluid begins to pour out.
• After the end of the manipulation, the woman is in a horizontal position for 30 minutes. The condition of the fetus is monitored by the KGT apparatus.

The bladder is necessarily opened in the absence of contractions, which leads to the convenience and safety of the operation.

What does a woman feel during an amniotomy?

Bladder puncture before childbirth - does it hurt or not? Any woman is afraid of such a procedure because of the possible pain. However, in this case, unpleasant sensations are not observed, because the amniotic fluid has no nerve endings.

A woman just needs to relax and take a comfortable position. All that she can feel after a properly performed procedure is only the flow of amniotic fluid.

With muscle tension, unpleasant sensations and negative consequences can occur in the form of injury to the walls of the vagina.

Mandatory conditions

What are the conditions for a bladder puncture before childbirth? To avoid complications during the procedure, you must follow some rules. These include:

• correct presentation of the fetus (head);
• pregnancy, the duration of which is at least 38 weeks;
• natural delivery and the absence of restrictions to this;
• preparation of the birth canal;
• pregnancy with one fetus.

The importance lies in the readiness and maturity of the uterus. When performing an operation, it must correspond to 6 points on the Bishop scale.

Complications and consequences of amniotomy

With an error-free bladder puncture before childbirth, the whole process is safe. But there are a few exceptions when labor can be more difficult after an amniotomy. There are the following consequences:

• trauma to the umbilical cord vessel, if it is attached to the membrane, which can lead to blood loss;
• the child's condition worsens;
• the loops of the umbilical cord or the limbs of the fetus (arms, legs) fall out;
• violation of the child's heartbeat;
• rapid labor activity;
• secondary birth weakness.

There is a risk that a puncture of the fetal bladder will not lead to the desired result and labor will not become active. Therefore, doctors resort to using drugs that cause contractions. In some situations, a woman undergoes a cesarean section, because a child's prolonged stay without water is fraught with negative consequences.

How long does labor last after a bladder puncture before childbirth? Reviews of women who have gone through this procedure are as follows:

• for women who gave birth for the first time, childbirth took place within 7-14 hours;
• in multiparous women, this can take 5-12 hours.

Any intervention, which can include a bladder puncture, sometimes leads to consequences that are not always positive. Amniotomy should be performed in compliance with all the necessary conditions, which will reduce the risk of complications of various kinds. Therefore, if this procedure is necessary, women should not refuse surgery and other manipulations necessary during childbirth.

Why amniotomy needed? Can you do without it? Will she harm mom or baby? We figure it out together with our expert - Yulia DREMOVA, obstetrician-gynecologist at the Avicenna Medical Center.

According to statistics, amniotomy or, simply put, a puncture of the fetal bladder is used in our country in about seven out of a hundred births.

Sibmama data based on surveys of women who have recently given birth ( ) , radically differ from the official statistics: last year, a puncture of the fetal bladder became the most common intervention in the process of childbirth: it was least often resorted to in maternity hospital No. 2 (38% of cases), most often in the maternity hospital of the 25th medical unit (68% of cases).

In 2015, 541 out of 1,426 women in labor who completed the amniotomy, according to a new survey, (among them there are those who have undergone a cesarean section, i.e. amniotomy is performed at least every third woman).

What happens to the fetal bladder during childbirth

The fetal bladder - the baby's first "home" - is a strong, thin and very elastic "pouch". It is filled (in medical language, they are called amniotic fluid): a warm (about 37 degrees) comfortable environment that reliably protects the baby from external influences: noise, pressure, ascending infections.

What happens to the fetal bladder when contractions begin? The muscles of the uterus begin to squeeze it with force. Amniotic fluid begins to move and part of the fluid (about 200 ml) moves downward, forming a kind of "water cushion", which, with each uterine contraction, presses on the cervix and helps it open. Normally, the bladder ruptures when the cervix is \u200b\u200balready wide enough - by 4-6 cm.The lower part of the bladder penetrates deeper into the inner os of the cervix, the pressure increases, the bladder breaks and the amniotic fluid that was from below is poured out.

From this moment on, the baby's head begins to press directly on the cervix, the opening accelerates, bringing the moment of the baby's birth closer. This is not only due to increased pressure, but also because the rupture of the bladder is accompanied by the release of biologically active substances - prostaglandins, which stimulate uterine contraction.

Why amniotomy is needed

“Why open the fetal bladder at all, if the waters go away on their own, and suddenly this stimulation disrupts the natural course of labor?” - many women in labor express such concerns. But the fact is that when childbirth takes place naturally and without complications, the need for an amniotomy does not arise. Simply put, if you can do without a puncture of the fetal bladder, then the doctors are happy to do.

The procedure may be required when the condition of the child or mother requires urgent delivery, or when labor is weak. Also, a puncture is a way out in a number of cases when the natural sequence of the birth process is violated. The fetal membranes can be so strong that they do not break and a puncture is required, another common reason for amniotomy during childbirth is the so-called "flat bladder", when there is no fluid in its lower part and the fetal membranes tighten the baby's head and interfere with its advancement and disclosure cervix.

However, it is not at all harmful to remember the indications for which this procedure is done, so that, if necessary, it is good to understand what is happening.

Expert commentary

Indications for amniotomy:

• induction of labor during prolongation;
• weakness of labor;
• , ;
• "Flat" fetal bladder (fetal membranes are stretched over the head of the fetus, interfere with its movement through the birth canal);
• complete opening of the uterine pharynx, if the fetal bladder did not open on its own (dense membranes);
• in case of multiple pregnancies, after the birth of the first fetus, an amniotomy of the second fetal bladder is performed;
• suspicion of fetal hypoxia and premature placental abruption;
• the condition of the pregnant woman, which does not allow further prolongation of the pregnancy;
• carrying out an amniotomy is desirable before labor pain relief using the prolonged .

From the moment the integrity of the bladder is violated, there is no turning back - it counts for hours, because the anhydrous period cannot last indefinitely (usually doctors recommend limiting the time interval from the opening of the bladder to the onset of labor by 10-12 hours, but this issue is resolved in each case individually).

The article discusses how to pierce the bladder during childbirth. We will tell you why this procedure is carried out and whether it hurts. You will find out what are the contraindications for a puncture.

The value of amniotic fluid

Amniotic fluid plays an important role in childbirth. They usually leave shortly after the beginning of the birth process. If the water has departed at your home, then you should immediately go to the hospital. Don't worry about missing the drain. By volume, they are approximately equal to one glass.

So what is the role of amniotic fluid? The contractions work on the neck, promoting its opening. They also promote the child through the birth canal. The cervix softens and unfolds, and this process takes place by contraction of the muscles of the uterus. But also the opening occurs when exposed to the fetal bladder.

Contractions cause, the pressure inside this organ increases, the bubble becomes tense. In this case, the amniotic fluid is directed downward. The lower region of the bladder penetrates the inner pharynx and helps open the neck.

Most often, the bladder ruptures if the neck has opened completely or partially. First, the front waters flow out, which are in front of the child's head. In this case, the woman in labor does not experience anything, since there are no nerve endings in the fetal bladder.

In some cases, the bladder ruptures in the area of \u200b\u200bcontact with the wall of the uterus. Because of this, the water does not flow out rapidly, but only drop by drop, which is not always noticeable with the naked eye.

Normal waters are clear in color and odorless. Cloudy water or an unpleasant odor means the presence of infections in the body of a pregnant woman or recent illnesses.

In the event that the fetal bladder does not rupture by itself, experts perform an amniotomy. This is the name of the operation to open the amniotic fluid.

What is amniotomy

There are several types of puncture:

• prenatal - carried out to stimulate contractions and labor;
• early - performed in case of neck opening up to 7 cm;
• timely - carried out when the neck opens from 8 to 10 cm;
• belated - performed to prevent the development of hypoxia in the child and bleeding in the mother.

When carrying out a puncture, the process of childbirth is no different from a conventional delivery, in which the bladder ruptures naturally. At the same time, specialists monitor the condition of the fetus using KGT.

When a bladder puncture is needed

As a rule, amniotomy is performed in cases of emergency delivery. Sometimes the procedure is carried out due to the absence of contractions in the following cases:

1. Postterm pregnancy. Typically, pregnancy lasts 40 weeks. If the expectant mother walks over this period, doctors begin to think about a bladder puncture. This is due to the onset of aging of the placenta and the loss of its ability to perform its functions. First of all, this negatively affects the health of the child, since hypoxia begins.
2. Gestosis is a disease, the main symptoms of which are edema, high blood pressure, and the presence of protein in the urine. The disease negatively affects the well-being of the pregnant woman and the fetus.
3. Rhesus conflict. This pregnancy belongs to the category of difficult, for this reason, stimulation of the labor process is required.

If the birth process has begun, then the puncture is applied:

• With weak labor. If, after a certain time, the contractions become weaker instead of increasing, the cervix slows down the labor process, then an amniotomy is performed. This measure allows you to speed up the contractions. If there are no changes a few hours after the puncture, then the woman in labor is given an oxytocin drip.
• When, since a large amount of water prevents the uterus from contracting.
• With increased blood pressure. Diseases of the kidneys and heart, as well as gestosis, provoke an increase in blood pressure. This situation can adversely affect the process of childbirth and the condition of the fetus.
• With a flat bubble. In such a case, there is almost no anterior water, because of which the process of childbirth is difficult or completely stopped.
• With low placentation. This position of the placenta can cause bleeding or placental abruption.

Contraindications

Sometimes amniotomy is prohibited. Namely:

• the presence of herpes on the genitals of a pregnant woman;
• the loops of the umbilical cord interfere with the puncture;
• natural childbirth is undesirable;
• finding the fetus not in the head presentation.

How is an amniotomy performed?

Bladder puncture is equivalent to an operation, but during it there is no need for the presence of an anesthesiologist and a surgeon. Mommies' comments about the procedure are positive, since it does not bring any discomfort or pain.

After the doctor examines the mother-to-be on the chair, he proceeds to the puncture. Amniotomy includes several stages:

• Before the operation, the pregnant woman takes an antispasmodic. After it begins to act, the pregnant woman lies down in the gynecological chair.
• The specialist puts on gloves. Then, with a gentle movement, he inserts a special instrument into the female genital organ. He hooks the bubble with the tool and pulls it towards himself until it bursts. Then water is poured out.
• After the puncture, the expectant mother should be in a supine position for half an hour. At this time, the child's condition is monitored using CT.

A puncture is made if there are no contractions, which makes the operation completely safe.

Amniotomy is done only in special cases. You should not be afraid of her, since she does not cause any pain to either the pregnant woman or the fetus. After the puncture, labor activity improves, which means that the time before meeting with the newborn decreases.

Obey doctors during childbirth and do not be afraid of anything! Only in this case, the birth will be successful and without any complications! Be healthy and have an easy delivery!

See you in the next article!