Induction Of Labor - Artificial Rupture Of Membranes (Amniotomy) -

Artificial rupture of membranes, also known as amniotomy, is a procedure to induce labor, and to exclude the presence of meconium in the amniotic fluid.
It is usually performed during the active phase of the first stage of labor.
Amniotomy should be done in a labor room, and not in the antenatal ward.
Before the procedure, the mother should be positioned into the dorsal position, and the person who performs amniotomy should scrub and wear a gown, since this is a strict aseptic procedure.
At first, explain the procedure to the mother.
Then, clean the vulva with 5 antiseptic swabs.
Perform a vaginal examination to assess the cervical dilatation and effacement, exclude cord presentation and identify the presenting part, to assess the position and level of the presenting part, and to feel the membranes.
Amniotomy is usually done when the cervical dilatation is about 5 to 6 centimeters.
If the conditions are satisfactory, then go for the amniotomy.
Keep the fingers on the fetal head, as you can see in this picture.
Drive a blunt, long artery forceps along the fingers until it meets the fetal head.
The forceps should not be opened until it reaches the fetal head.
Then grab the membranes and pull.
If the membranes are ruptured, amniotic fluid will come out.
Normal amniotic fluid has a milk color.
Drain the fluid slowly while keeping the fingers intact, otherwise the cord will prolapse.
After amniotomy, auscultate for fetal heart sounds and run a CTG to assess fetal wellbeing.
It is important to keep in mind that amniotomy should be delayed if the presenting part is breech and in high head presentations.
Finally, the risks of amniotomy include cord prolapse, sepsis, tissue trauma, and placental abruption.

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