Amniotomy and Amnioinfusion (Nursing)

00:01 So sometimes we have some other procedures that might be used to help speed up labor, and one of those procedures is called an amniotomy, also known as artificial rupture of membranes or AROM.

00:14 So sometimes you see AROM in the chart and now you know what it is.

00:18 So what is the procedure? A small hook.

00:21 It actually looks like a crochet needle with a very sharp tip and we actually apply that to the amniotic sac and put a hole in it.

00:30 And then sometimes a provider will make the hole just a little bit bigger so that more amniotic fluid will come out.

00:37 So the indication is that it might be used to speed up labor or if we need to place internal monitors or do an amnioinfusion, which we'll talk about a little bit later, then we have to open the sac in order to do that.

00:51 So what are the risks, because there are definitely some.

00:54 The first one, infection.

00:56 So hopefully you're starting to see the trend.

00:58 If we open the sac, the chances for infection for the fetus go up.

01:03 Prolapsed cord, so imagine if the fetus is very high up in the pelvis and there's lots of fluid and we poke a hole in the fluid while the baby's up, still really high, the potential for the umbilical cord to just find its way down through the cervix is very possible.

01:19 So we want to make sure when an amniotomy is done that the station is low.

01:24 So we want to be zero or even plus station before we do an amniotomy. Fetal distress, so thinking about the fact that if we have a cord prolapse or the baby drops down in station really fast, that may cause some discomfort and we might see that on the fetal monitor strip.

01:44 So how does the nurse prepare for the amniotomy? Well, the first thing you want to do is prepare the client.

01:49 They need to know that hopefully during the rupture, the actual poking of the amniotic sac, they won't feel anything.

01:56 But immediately after, they're going to feel lots of fluid rushing down and they may continue to leak over the rest of the duration of labor.

02:03 And they should know that.

02:05 We also want to confirm the station.

02:07 So if you remember the station, it goes minus, zero, and then plus.

02:11 So a station above a -1 is considered pretty high for an amniotomy.

02:15 So make sure you know what that is before the provider rupture these membranes.

02:20 The next thing you want to do is confirm the fetal heart tones immediately after the amniotomy. So think about if a prolapsed cord were to occur, one of the ways we would know it is that we would hear that heart rate begin to drop.

02:33 So it's important to check the fetal heart tones after the bag of water is broken, the risk of infection goes up.

02:40 And one of the ways we might know that is because the maternal temperature begins to rise. So check the maternal temperature every two hours after amniotomy and monitor for any other signs of infection.

02:53 So a change in the color of the fluid that comes out or the way it smells.

02:58 And again, maternal temperature.

03:01 The next procedure is the amnioinfusion, and remember, we just talked about the amniotomy as being one of the things we have to do first.

03:08 So membranes have to be ruptured.

03:11 Sometimes it'll happen spontaneously.

03:13 Sometimes the provider will have to do it.

03:15 But membranes have to be ruptured in order to do the amnioinfusion.

03:19 So a catheter is actually placed inside the amniotic sac and warmed normal saline or lactated Ringer's is going to be placed inside the uterus. So if you look at the setup, it kind of looks like an IV, except it has to be warm. You wouldn't want to take a bath in cold water.

03:36 So we're not going to do that to the fetus.

03:38 We're going to make sure that it's warm to body temperature before we introduce that fluid to the uterine cavity.

03:44 And remember, it's inside the sac.

03:46 We don't want to place it outside the sac because that actually can cause a placental abruption. So let's think about the indication for the amnioinfusion, so in your mind, again, picture what's going on.

03:59 We're introducing fluid into the amniotic sac.

04:02 What's the purpose of the fluid? Exactly, it provides a cushion for the cord, so if we have a situation where the client's experiencing oligohydramnios, a low amount of fluid, we can replace the fluid in the uterine cavity or add more to float the cord.

04:20 Now, here's a tip. We used to use an amnioinfusion as a way to dilute the meconium that might be there.

04:27 So meconium is that stool, that early stool that a baby has that's really thick and sticky. And we found that if it gets into the respiratory tract, it can cause respiratory distress.

04:38 So we thought if we could dilute it, if the baby got it into their respiratory tract, it would then it out and maybe decrease those complications.

04:47 Research told us that wasn't exactly true.

04:49 So we don't use it for that purpose anymore.

04:54 When we set up an amnioinfusion, we have to think about the risks, so because the sac is open, the risk of infection is there.

05:02 And also, we're sticking a catheter inside the uterine sac.

05:06 So we're dragging that catheter through the vagina and any bacteria that might be there is being dragged with it.

05:12 So infection is a really important thing to consider.

05:15 Also, we want to consider overextending the uterus.

05:19 So the uterus definitely has a capacity and we're introducing 500 milliliters of fluid into the uterus.

05:26 So if we're not careful and we just let that IV run, we could introduce a whole lot of fluid into a uterus that can't manage that.

05:34 So overdistention, it's definitely a possibility.

05:38 So what does the nurse need to do? Well, we need to monitor those fluids and make sure that we don't overstimulate and overextend the uterus.

05:45 So hopefully we'll notice that the fluid is going in and it's also coming out.

05:50 We want to keep the fluids warm because cold fluids will put the baby into shock.

05:55 Not what we want to do.

05:57 We want to monitor the fetal heart rate and make sure that it remains stable.

06:01 And then we want to monitor for uterine distension.

06:03 So important.

06:05 I think I've said it twice and I'll say it three times.

06:08 Monitor for uterine distension.