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.
So sometimes you see AROM in the chart and
now you know what it is.
So what is the procedure?
A small hook.
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.
And then sometimes a provider will make the
hole just a little bit bigger so that more
amniotic fluid will come out.
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.
So what are the risks, because there are
The first one, infection.
So hopefully you're starting to see the
If we open the sac, the chances for
infection for the fetus go up.
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.
So we want to make sure when an amniotomy is
done that the station is low.
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.
So how does the nurse prepare for the
Well, the first thing you want to do is
prepare the client.
They need to know that hopefully during the
rupture, the actual poking of the amniotic
sac, they won't feel anything.
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.
And they should know that.
We also want to confirm the station.
So if you remember the station, it goes
minus, zero, and then plus.
So a station above a -1 is considered pretty
high for an amniotomy.
So make sure you know what that is before
the provider rupture these membranes.
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.
So it's important to check the fetal heart
tones after the bag of water is broken,
the risk of infection goes up.
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
So a change in the color of the fluid that
comes out or the way it smells.
And again, maternal temperature.
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.
So membranes have to be ruptured.
Sometimes it'll happen spontaneously.
Sometimes the provider will have to do it.
But membranes have to be ruptured in order
to do the amnioinfusion.
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
So we're not going to do that to the fetus.
We're going to make sure that it's warm to
body temperature before we introduce that
fluid to the uterine cavity.
And remember, it's inside the sac.
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
We're introducing fluid into the amniotic
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.
Now, here's a tip. We used to use an
amnioinfusion as a way to
dilute the meconium that might be there.
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
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
Research told us that wasn't exactly true.
So we don't use it for that purpose anymore.
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.
And also, we're sticking a catheter inside
the uterine sac.
So we're dragging that catheter through the
vagina and any bacteria that might be there
is being dragged with it.
So infection is a really important thing to
Also, we want to consider overextending the
So the uterus definitely has a capacity and
we're introducing 500
milliliters of fluid into the uterus.
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
So overdistention, it's definitely a
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.
So hopefully we'll notice that the fluid is
going in and it's also coming out.
We want to keep the fluids warm because cold
fluids will put the baby into shock.
Not what we want to do.
We want to monitor the fetal heart rate and
make sure that it remains stable.
And then we want to monitor for uterine
I think I've said it twice and I'll say it
Monitor for uterine distension.