What criteria should be met before performing an amniotomy?
- The mother should be in active labor (four or more cm dilated)
- The mother should be at term.
- The head should be engaged (0 station or more)
- There should be an indication for the procedure.
How can an amniotomy affect your birth?
Once the bag of waters has been ruptured, you are committed to delivery. There is no turning back. Studies show that bacteria gain access to the uterus within minutes of membrane rupture and infection can develop within 12 to 24 hours if the baby is not born. In most medical centers, cultures for chlamydia, gonorrhea and group b beta strep are performed in the event of spontaneous rupture of membranes without labor. Antibiotics are started by 18 hours post rupture.
There are some studies which demonstrate that this intervention may make it more difficult for the baby to turn from a posterior to the more favorable anterior position in labor. Some literature points to the fact that fetal head compression may be more common if the amniotic fluid is lost.
Are there potential complications?
In general, a healthy baby is able to tolerate amniotomy with no problem.
The most dreaded complication directly attributed to artificial rupture of membranes is prolapse of the umbilical cord. If the baby's presenting part is engaged and well applied to the cervix, the risk of this complication is very low. Of course, if the cord comes down to sit between the hard bony pelvis and the baby's head, compression may occur and asphyxia may result.