Artificial rupture of membranes surgery steps

Artificial rupture of membranes is a procedure that can solve the symptoms of difficult labor in pregnant women. This surgery was often used in the past when medical technology was underdeveloped. It can help pregnant women give birth. It mainly involves puncturing the fetal membranes by hand, guiding the fetal head into the pelvis, and finally achieving a smooth delivery. For the surgical procedure of artificial rupture of membranes, we first dilate the uterus to more than 3 cm, and then use the uterine contractions to guide the delivery of the fetus.

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 about 50%, the success rate for scores of 7 to 9 is about 80%, and all scores above 9 are successful.

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.