Indications for artificial rupture of membranes

The indication for artificial rupture of membranes is that the cervix is ​​dilated more than 3 cm, the fetal head can be seen, and the cephalopelvic area is asymmetrical. This procedure requires the doctor to have certain medical skills, otherwise it will affect the delivery process of the pregnant woman. The artificial rupture of membranes requires the fingers to remain in the vagina after the operation, and after 1 to 2 uterine contractions, the fetal head will be moved into the pelvic cavity, so that the pregnant woman can give birth to the baby smoothly.

Indications for artificial rupture of membranes: cervical dilation ≥ 3cm, no cephalopelvic disproportion, head and neck connected

Surgical procedures

Surgical steps for artificial rupture of membranes: if the cervix is ​​dilated ≥ 3 cm, there is no cephalopelvic disproportion, the fetal head is engaged, there is no umbilical cord prolapse and placenta previa, check the cleanliness of the vagina and perform a vaginal examination with strict disinfection. Between two contractions, insert the left middle and index fingers into the vagina to guide, hold the toothed forceps in the right hand to clamp, tear the fetal membrane, and use the fingers to widen the rupture. After rupturing the membrane, the operator's fingers should remain in the vagina. After 1 to 2 contractions, when the fetal head enters the pelvis, the operator removes the fingers and pays attention to whether the fetal hair is visible, the amount of amniotic fluid flowing out, and the color of the amniotic fluid. Listen to the fetal heartbeat after rupture of the membrane. When there is little amniotic fluid, gently push up the fetal head to facilitate the outflow of amniotic fluid, making it easier to make a judgment.

When there is too much amniotic fluid, use a long needle to rupture the membrane at a high position, and use your fingers to block the cervix to allow the amniotic fluid to flow out slowly to prevent a sudden drop in intrauterine pressure from causing placental abruption. It should be used with caution if the fetal head floats high.

Precautions

Indications:

(1) Induced labor for post-term pregnancy.

(2) The labor process is prolonged and the fetal head is fixed.

(3) Excessive amniotic fluid requires termination of pregnancy.

(4) Partial placenta previa.

(5) If the following conditions are met, rupture of membranes may be performed before induction of labor:

① The cervix is ​​mature;

②The presenting part is close to the cervix;

③Fix the presenting part.

Bishop proposed using the cervical maturity scoring method to estimate the effectiveness of measures to enhance uterine contractions, see Table 1. If the maternal score is 3 points or below and artificial rupture of membranes has failed, other methods should be used. The success rate for scores of 4 to 6 is approximately 50%, for scores of 7 to 9 is approximately 80%, and for scores above 9, all are successful [1].

Danger:

(1) Umbilical cord prolapse: If the presenting part is high and not close to the cervix;

(2) Placental abruption;

(3) If there is too much amniotic fluid, there is a risk of umbilical cord prolapse and placental abruption.

Timing and pros and cons

Spontaneous rupture of membranes is an important clinical manifestation of the first stage of labor. When the fetal presenting part is connected, the amniotic fluid is blocked into two parts. The amniotic fluid in front of the presenting part is the anterior amniotic fluid. As labor progresses, the pressure in the anterior amniotic fluid increases. When it reaches a certain level, the fetal membrane ruptures and the amniotic fluid flows out. Under normal circumstances, the cervix is ​​almost fully dilated or fully dilated at this time. Artificial rupture of membranes has certain indications. If there is an abnormal labor process, such as prolonged latent period, delayed cervical dilation, etc., artificial rupture of membranes can be performed based on the mother's uterine contractions and the speed of cervical dilation. Only when fetal cephalopelvic misalignment and malposition are excluded. In clinical work, our hospital generally performs artificial rupture of membranes when the cervix is ​​dilated to about 3 cm and uterine contractions are weak. Intravenous access is routinely established before rupture of membranes to facilitate emergency treatment in case of abnormal conditions after rupture of membranes. After rupture of membranes, on the one hand, the color of the amniotic fluid can be observed, thereby indirectly observing the condition of the fetus in the uterus. If the amniotic fluid is clear and the labor process has not stopped, continue to wait for delivery; if the amniotic fluid is grade I and the labor process has not stopped, continue to wait for delivery while closely observing the fetal heart rate and perform fetal heart monitoring when necessary. The observation time for delivery generally does not exceed 2 hours. If there are any abnormalities, surgical delivery will be performed immediately to end the pregnancy. If the amniotic fluid is II degree and the delivery cannot be ended immediately, a cesarean section should be performed immediately. On the other hand, rupturing membranes when uterine contractions are poor can strengthen uterine contractions and shorten labor. The woman should be observed for about an hour after rupture of membranes. If the uterine contractions are not significantly stronger than before, oxytocin can be given to strengthen the uterine contractions and promote delivery. Of course, uterine contractions should be closely observed after rupture of membranes to avoid excessive uterine contractions caused by rupture of membranes, which may cause fetal distress or induce placental abruption, resulting in severe obstetric emergencies.