They prick the bubble. Puncture of the amniotic sac - does it hurt? Will it hurt

In utero, the child is protected by a special membrane - the amnion, filled with amniotic fluid. They protect it from shock when moving, and the shell prevents the upward penetration of infection from the vagina.

During childbirth, the baby's head is pressed against the cervix and a fetal bladder is formed, which, like a hydraulic wedge, gradually stretches the cervix and forms birth canal. Only after this does it break on its own. But there are situations when the bladder is punctured before childbirth without contractions.

This procedure is not prescribed at the request of the woman or the whim of the doctor. Successful amniotomy is possible if certain conditions are met:

the fetal head is presented;
full-term pregnancy of at least 38 weeks with one fetus;
estimated fetal weight more than 3000 g;
signs of a mature cervix;
normal pelvic size;
There are no contraindications for natural childbirth.

Types of amniotomy

The moment of the puncture determines the type of procedure:

Prenatal - is carried out before the onset of contractions, its purpose is to induce labor.
Early - before the cervix is dilated by 6-7 cm, it can speed up this process.
Timely - performed during effective contractions, the opening of the cervix is 8-10 cm.
Belated - in modern conditions it is rarely carried out, it is performed at the time of expulsion of the fetus. Amniotomy is needed to prevent bleeding in the woman in labor or hypoxia in the child.

How is childbirth after a bladder puncture? The process of the birth of a child in this case does not differ from the natural one. In any case, the condition of the fetus is monitored using a CTG machine.

Indications for bladder puncture during childbirth

Bladder puncture stimulates planned labor or is performed during it.

Labor induction using amniotomy is indicated in the following cases:

gestosis, when indications for urgent delivery appear;
premature placental abruption;
fetal death in utero;
post-term pregnancy;
heavy chronic diseases of cardio-vascular system, lungs, kidneys, in which delivery is indicated from 38 weeks;
Rh conflict between mother and child;
pathological preliminary period.

The latter condition is the occurrence of small contractions over several days, which do not develop into normal labor. This causes intrauterine suffering of the fetus from lack of oxygen and fatigue of the woman.

How long will it take for labor to begin after the bladder is punctured? The onset of labor is expected no later than 12 hours later. Although nowadays doctors do not allow that much time for waiting. Prolonged stay of a child in a waterless environment increases the risk of infection. Therefore, 3 hours after opening the amnion, if contractions have not begun, stimulation with medications is used.

When labor has already developed, the puncture is performed according to the following indications:

The cervix dilated 6-8 cm, but the water did not break. Their further preservation is impractical; the bubble no longer fulfills its function.
Weakness of labor. Puncture of the bladder in most cases leads to its activation. After amniotomy, wait 2 hours; if there is no improvement, then resort to stimulation with oxytocin.
Polyhydramnios overstretches the uterus and prevents normal contractions from developing.
With oligohydramnios, a flat amniotic sac is observed. It covers the baby's head and does not function during childbirth.
Low attached placenta may begin to peel off after contractions develop. And opening the amnion will allow the fetal head to press tightly against the lower segment of the uterus and contain abruption.
In case of multiple pregnancy, the bladder of the second child is punctured 10-15 minutes after the appearance of the first.
High arterial pressure decreases after water opening.

Technique for puncturing a mother's bladder

30 minutes before inducing labor, the woman is given the antispasmodic Drotaverine by puncture of the bladder.
Later, an examination is carried out on the obstetric chair; the doctor evaluates the cervix and the location of the head.
With a sliding movement of your fingers, a special jaw - a hook - is inserted into the vagina.
With its help, the membrane clings during contractions, and the gynecologist inserts a finger into the resulting hole. The tool is removed.
Holding the fetal head through the abdomen with the other hand, the membranes are carefully separated and the anterior amniotic fluid is released.

They are collected in a tray and their condition is visually assessed. Green water with meconium flakes indicates intrauterine fetal hypoxia. This condition deserves additional attention. The pediatric service is notified in advance of the child’s possible condition.

If a large volume of water is drained at once, this can lead to the loss of umbilical cord loops or small parts of the fetal body.

After the procedure, the mother in labor is connected to a CTG machine for 30 minutes to assess the baby’s condition.

Is it painful or not to puncture the bladder before giving birth? The shells are not penetrated nerve endings, so the procedure is absolutely painless.

However, complications sometimes develop:

traumatization of the umbilical cord vessel if it was attached to the membrane;
loss of umbilical cord loops or parts of the fetal body (arms, legs);
deterioration of the fetus;
rapid labor activity;
secondary birth weakness;
child infection.

How long does labor last after bladder puncture? The duration depends on their parity or quantity:

In primigravidas, the normal duration of labor is 7-14 hours.
Multiparous women require less time - from 5 to 12.

Contraindications for bladder puncture in a pregnant woman

Despite the ease of implementation and a large number of complications of manipulation, there are serious contraindications for its implementation. Most of them coincide with contraindications for natural childbirth:

Herpetic rashes on the perineum will lead to infection of the child.
Pelvic, leg, transverse or oblique presentation of the fetus, umbilical cord loops in the head area.
Complete placenta previa. Childbirth in this case is impossible - the placenta is attached above the internal os and prevents the lower segment of the uterus from unfolding.
Inconsistency of the scar on the body of the uterus after caesarean section or other surgical interventions.
Narrowing of the pelvis 2-4 degrees, bone deformities, tumor processes in the pelvis.
The weight of the fetus is more than 4500 g.
Rough scars causing deformation of the cervix or vagina.
Triplets, conjoined twins, breech presentation of the first child of twins.
High myopia.
Delayed fetal development 3rd degree.
Acute fetal hypoxia.

In the absence of the listed contraindications, amniotomy is a safe procedure and does not affect the condition of the fetus.

Yulia Shevchenko, obstetrician-gynecologist, especially for the site

Useful video

In the article we discuss how the bladder is pierced during childbirth. We tell you why this procedure is performed and whether it hurts. You will find out what contraindications there are for punctures.

The value of amniotic fluid

Amniotic fluid plays an important role during childbirth. They usually go away shortly before the birth process begins. If your water breaks at home, you should immediately go to the maternity hospital. Don't worry about missing your water's break. They are approximately equal in volume to one glass.

So what is the role of amniotic fluid? Contractions affect the cervix, promoting its opening. They also move the baby through the birth canal. The cervix softens and opens, and this process occurs through contraction of the muscles of the uterus. But dilatation also occurs when exposed to the amniotic sac.

Contractions cause pain, the pressure inside this organ increases, the bladder tightens. In this case, the amniotic fluid is directed downwards. The lower area of the bladder penetrates the internal os and helps open the cervix.

Most often, the bubble ruptures if the neck is fully or partially dilated. The front waters, which are in front of the baby's head, flow out first. In this case, the woman in labor does not experience anything, since there are no nerve endings in the amniotic sac.

In some cases, the bladder ruptures in the area of contact with the wall of the uterus. Because of this, water does not flow out quickly, but only drop by drop, which is not always noticeable to the naked eye.

Normal waters are clear in color and odorless. Turbid waters or an unpleasant odor indicate the presence of infections in the pregnant woman’s body or recent illnesses.

In the case where the amniotic sac does not rupture on its own, specialists perform an amniotomy. This is the name of the operation to open the amniotic sac.

What is amniotomy?

There are several types of puncture:

prenatal - carried out to stimulate contractions and the birth process;
early - performed when the cervix is dilated to 7 cm;
timely - carried out when the cervix is dilated from 8 to 10 cm;
belated - performed to prevent the development of hypoxia in the child and bleeding in the mother.

When a puncture is performed, the process of childbirth is no different from normal childbirth, in which the bladder ruptures natural method. At the same time, specialists monitor the condition of the fetus using CHT.

When do you need a bladder puncture?

As a rule, amniotomy is performed in cases of emergency childbirth. Sometimes the procedure is carried out due to the absence of contractions in the following cases:

Post-term pregnancy. Typically, pregnancy lasts 40 weeks. If the expectant mother goes beyond this period, doctors begin to think about puncturing the bladder. This is due to the onset of aging of the placenta and its loss of the ability to perform its functions. First of all, this negatively affects the child’s health, as he begins to experience hypoxia.
Preeclampsia is a disease whose main symptoms are swelling, high blood pressure, and the presence of protein in the urine. The disease negatively affects the well-being of the pregnant woman and the fetus.
Rhesus conflict. This pregnancy is classified as difficult, for this reason stimulation of the birth process is required.

If the birth process has begun, then the puncture is applied:

With weak labor activity. If, after a certain time, contractions become weaker instead of increasing, and the cervix slows down the birth process, then an amniotomy is performed. This measure allows you to speed up contractions. If a few hours after the puncture there are no changes, then the woman in labor is given an oxytocin drip.
With, since a large amount of water prevents the contraction of the uterus.
With high blood pressure. Kidney and heart diseases, as well as gestosis, provoke an increase in blood pressure. This situation can negatively affect the birth process and the condition of the fetus.
With a flat bubble. In such a case, there is almost no anterior water, which makes the birth process difficult or completely stopped.
With low placentation. This position of the placenta can cause bleeding or placental abruption.

Contraindications

Sometimes amniotomy is prohibited. Namely:

the presence of herpes on the genitals of a pregnant woman;
umbilical cord loops interfere with puncture;
natural childbirth is undesirable;
the fetus is not in a cephalic position.

How is an amniotomy performed?

Puncture of the bladder is equivalent to an operation, but during it there is no need for the presence of an anesthesiologist and surgeon. Feedback from mothers about the procedure is positive, as it does not bring any discomfort or pain.

After the doctor examines the expectant mother in a chair, he proceeds with the puncture. Amniotomy includes several stages:

Before the operation, the pregnant woman takes an antispasmodic drug. After it begins to act, the pregnant woman lies down in the gynecological chair.
The specialist puts on gloves. Then, with a gentle movement, a special instrument is inserted into the female genital organ. He catches the bubble with a tool and pulls it towards himself until it bursts. Then the waters pour out.
After the puncture, the expectant mother should remain in a lying position for half an hour. At this time, the child’s condition is monitored using CHT.

The puncture is performed if there are no contractions, which ensures the complete safety of the operation.

Amniotomy is performed only in special cases. You should not be afraid of it, since it does not cause any pain to either the pregnant woman or the fetus. After the puncture, labor improves, which means the time before meeting the newborn is reduced.

During childbirth, listen to your doctors and don’t be afraid of anything! Only in this case will the birth be successful and without any complications! Be healthy and have an easy birth!

See you in the next article!

During all 3 pregnancies I was afraid that my water would break somewhere in a public place... I was just sleeping and saw that I was standing like this in a full tram, and the water was so loud and poured out like a bucket. Or in mall.. I woke up in a cold sweat =D

In short, I “was afraid,” my body took it too literally and my bubbles didn’t want to “burst” on their own, even at 42 weeks.

In all 3 pregnancies, my bladder was pierced already during the birth process, when contractions were going on, but the water still did not break.

DOES IT HURT?

It never hurt at all. Not a bit, not even felt. Perhaps this is because the puncture was done during contractions, and in comparison with them it seemed to me that the puncture was just flowers. At least the dilation examination was much more painful.

Indications:

With a flat shape of the amniotic sac. This means poor anterior water content, which leads to a delay in labor and even stopping contractions.
The amnion is too dense. With strong shells, independent opening does not occur even with the neck completely open. Giving birth to a baby in a bubble can be dangerous and the fetus may suffocate. Mommy may experience placental abruption or bleeding.
Weak labor. Non-productive contractions, no dilatation of the cervix, with multi-day contractions. If labor does not begin within two hours, drug induction is performed.
In post-term pregnancy. After 41 weeks of pregnancy, the placenta ages, and as a result, the fetus begins to starve of oxygen. Amniotomy accelerates the start of the labor process.
With polyhydramnios. The name speaks for itself: the amniotic sac contains a lot of water, this stretches the uterus and it is not able to fully contract. An amniotomy performed ahead of time, under the supervision of a doctor, will prevent the prolapse of loops from the umbilical cord and fetal limbs, if this happened spontaneously.
Rhesus conflict between mother and child. If there is a need for an urgent birth to save the fetus from death, the process of amniotomy is started.
Mommy has high blood pressure. Due to the decrease in volume after the opening of the bladder, the uterus ceases to exert pressure on the vessels near it.
Long-term toxicosis. In the third trimester, toxicosis is a pathology called gestosis: protein appears in the urine, the woman experiences swelling and blood pressure higher than normal.
Low lying placenta. With placenta previa, the entrance to the uterus itself is blocked, followed by placental abruption and fetal hypoxia.

I had several readings at once.

Amniotomy is performed without anesthesia; the walls of the amniotic bladder are devoid of nerve endings, so there is no need for pain relief.

As a rule, it is done at the initial stage of labor on a gynecological chair with a basin attached. Although in certain cases the bladder can be punctured both before the onset of labor and before the actual attempts.

And the second shock after the absence of pain was that the water did not pour out like a bucket, but only began to leak slightly. And if before the opening of the bladder I could at least somehow move, well, in order to increase the load and speed up the opening of the cervix, then after the opening I only had to lie down with a diaper between my legs. Panties/pads and other gadgets that make a woman’s life easier are of course prohibited during childbirth))

At the time when my bladder was pierced, the baby’s head was already tightly against the cervix, so the water simply could not “gushing out.” So they actually leaked the entire birth process a little bit at a time. In general, according to doctors, they shouldn’t gush out, because this is fraught with prolapse of the umbilical cord or even the baby’s arms/legs, and this is very dangerous. Therefore, together with the hook, the doctor inserts his index finger there and “releases” the water slowly.

The bladder is punctured with a special instrument. I don’t know what it’s called, but it looks like a huge crochet hook. On the Internet they often show sharper metal hooks, but for me the bubble was opened with a plastic one with a blunt end.

As a rule, after puncturing the bladder for five minutes, contractions become more frequent and stronger, and of course more painful.

The last time I suffered for a long time, I was already approaching the 42nd week of pregnancy and the baby was in no hurry to be born. Despite the fact that according to all the tests and ultrasound, everything was in order, but the cervix was not at all ready for childbirth.

At the consultation, a decision was made: to “give birth”; waiting any longer could be dangerous. But after spending an hour in the labor room with minor contractions, there was no result in the opening at all. We decided to puncture the bladder and inject oxytocin. And this is just a killer mixture, I realized that now there will be MEAT! And it began.

The fact is that if the amniotic sac is intact, all other methods of stimulation are powerless.

The contractions grew stronger and more frequent. After the bladder was punctured, the baby was born 2 hours later. These were 2 of the most hellish hours of my life, but thank you for 2, not 12)

In the first and second births I was allowed to suffer longer, the contractions went on for a loooong time, 14-15 hours, and only after the bladder was punctured the process went much faster.

In general, this is a completely standard procedure, which is done in 50% of cases. It is dangerous only in one respect: an inexperienced doctor can damage the baby’s head with the hook. Often after childbirth, babies have scratches on the top of their heads. We were spared this fate.

In home births, they prefer not to pierce the bladder if the waters have not broken on their own, but to give birth directly in the sac - I know girls who gave birth to children directly in the amniotic sac, and nothing, everyone is alive and well! Doctors are wary of this method. I have to believe the doctors, so of course I am FOR puncturing the bladder if necessary.

They say that among the contraindications there is a point about the weight of the fetus. They say you can’t do an amniotomy if the fetus weighs more than 3 kg. And here I cannot agree, all my children are much larger than this figure, and not by 100 grams. Doctors refute this point.

Contraindications:

In any case, this procedure has only advantages, so I advise you not to be afraid and not to panic))

During childbirth, the baby's head is pressed against the cervix and a fetal bladder is formed, which, like a hydraulic wedge, gradually stretches the cervix and forms the birth canal. Only after this does it break on its own. But there are situations when the bladder is punctured before childbirth without contractions.

This procedure is not prescribed at the request of the woman or the whim of the doctor. Successful amniotomy is possible if certain conditions are met:

the fetal head is presented;
full-term pregnancy of at least 38 weeks with one fetus;
estimated fetal weight more than 3000 g;
signs of a mature cervix;
normal pelvic size;
There are no contraindications for natural childbirth.

Types of amniotomy

The moment of the puncture determines the type of procedure:

Prenatal - is carried out before the onset of contractions, its purpose is to induce labor.
Early - before the cervix is dilated by 6-7 cm, it can speed up this process.
Timely - performed during effective contractions, the opening of the cervix is 8-10 cm.
Belated - in modern conditions it is rarely carried out, it is performed at the time of expulsion of the fetus. Amniotomy is needed to prevent bleeding in the woman in labor or hypoxia in the child.

Indications for bladder puncture during childbirth

Bladder puncture stimulates planned labor or is performed during it.

Labor induction using amniotomy is indicated in the following cases:

gestosis, when indications for urgent delivery appear;
premature placental abruption;
fetal death in utero;
post-term pregnancy;
severe chronic diseases of the cardiovascular system, lungs, kidneys, for which delivery is indicated from 38 weeks;
Rh conflict between mother and child;
pathological preliminary period.

When labor has already developed, the puncture is performed according to the following indications:

The cervix dilated 6-8 cm, but the water did not break. Their further preservation is impractical; the bubble no longer fulfills its function.
Weakness of labor. Puncture of the bladder in most cases leads to its activation. After amniotomy, wait 2 hours; if there is no improvement, then resort to stimulation with oxytocin.
Polyhydramnios overstretches the uterus and prevents normal contractions from developing.
With oligohydramnios, a flat amniotic sac is observed. It covers the baby's head and does not function during childbirth.
A low-attached placenta may begin to separate as contractions develop. And opening the amnion will allow the fetal head to press tightly against the lower segment of the uterus and contain abruption.
In case of multiple pregnancy, the bladder of the second child is punctured 10-15 minutes after the appearance of the first.
High blood pressure decreases after autopsy.

Technique for puncturing a mother's bladder

30 minutes before inducing labor, the woman is given the antispasmodic Drotaverine by puncture of the bladder.
Later, an examination is carried out on the obstetric chair; the doctor evaluates the cervix and the location of the head.
With a sliding movement of your fingers, a special jaw - a hook - is inserted into the vagina.
With its help, the membrane clings during contractions, and the gynecologist inserts a finger into the resulting hole. The tool is removed.
Holding the fetal head through the abdomen with the other hand, the membranes are carefully separated and the anterior amniotic fluid is released.

If a large volume of water is drained at once, this can lead to the loss of umbilical cord loops or small parts of the fetal body.

After the procedure, the mother in labor is connected to a CTG machine for 30 minutes to assess the baby’s condition.

Is it painful or not to puncture the bladder before giving birth? The membranes are not penetrated by nerve endings, so the procedure is absolutely painless.

However, complications sometimes develop:

traumatization of the umbilical cord vessel if it was attached to the membrane;
loss of umbilical cord loops or parts of the fetal body (arms, legs);
deterioration of the fetus;
rapid labor activity;
secondary birth weakness;
child infection.

How long does labor last after bladder puncture? The duration depends on their parity or quantity:

In primigravidas, the normal duration of labor is 7-14 hours.
Multiparous women require less time - from 5 to 12.

Contraindications for bladder puncture in a pregnant woman

Despite the simplicity of the procedure and the small number of complications of the manipulation, there are serious contraindications for its implementation. Most of them coincide with contraindications for natural childbirth:

Herpetic rashes on the perineum will lead to infection of the child.
Pelvic, leg, transverse or oblique presentation of the fetus, umbilical cord loops in the head area.
Complete placenta previa. Childbirth in this case is impossible - the placenta is attached above the internal os and prevents the lower segment of the uterus from unfolding.
Failure of the scar on the body of the uterus after cesarean section or other surgical interventions.
Narrowing of the pelvis 2-4 degrees, bone deformities, tumor processes in the pelvis.
The weight of the fetus is more than 4500 g.
Rough scars causing deformation of the cervix or vagina.
Triplets, conjoined twins, breech presentation of the first child of twins.
High myopia.
Delayed fetal development 3rd degree.
Acute fetal hypoxia.

In the absence of the listed contraindications, amniotomy is a safe procedure and does not affect the condition of the fetus.

Yulia Shevchenko, obstetrician-gynecologist, especially for the site

Useful video

Why is amniotomy needed? Is it possible to do without it? Will it harm the mother or baby? Let's figure it out together with our expert - Yulia DREMOVA, obstetrician-gynecologist medical center"Avicenna".

According to statistics, amniotomy or, simply put, puncture of the amniotic sac is used in our country in approximately seven births out of a hundred.

Sibmama data based on surveys of women who have recently given birth ( ) , radically differ from official statistics: last year, puncture of the amniotic sac became the most common intervention in the birth process: it was least often resorted to in maternity hospital No. 2 (38% of cases), most often in the maternity hospital of the 25th medical unit (68% of cases).

In 2015, according to a new survey, amniotomy was performed on 541 women in labor out of 1,426 who completed (among them there are those who had a caesarean section, i.e. amniotomy is performed on at least every third woman).

What happens to the amniotic sac during childbirth

The amniotic sac, the baby’s first “home,” is a strong, thin and very elastic “sac.” It's full (on medical language they are called amniotic fluid): a warm (about 37 degrees) comfortable environment that reliably protects the baby from external influences: noise, pressure, ascending infections.

What happens to amniotic sac When do contractions start? The muscles of the uterus begin to squeeze it with force. The amniotic fluid begins to move and part of the fluid (about 200 ml) moves down, forming a kind of “water cushion”, which with each uterine contraction presses on the cervix and helps it open. Normally, rupture of the bladder occurs when the cervix is already wide enough - 4-6 cm. The lower part of the bladder penetrates deeper and deeper into the internal os of the cervix, the pressure increases, the bladder ruptures and the amniotic fluid that was below flows out.

From this moment on, the baby’s head begins to press directly on the cervix, dilation accelerates, bringing the moment of the baby’s birth closer. This occurs not only due to increased pressure, but also because the rupture of the bladder is accompanied by biological release active substances- prostaglandins, which stimulate uterine contractions.

Why amniotomy is needed

“Why open the amniotic sac at all if the waters break on their own, what if this stimulation disrupts the natural course of labor?” - many women in labor express similar concerns. But the fact is that when childbirth occurs naturally and without complications, the need for amniotomy does not arise. Simply put, if you can do without puncturing the amniotic sac, then doctors are happy to do so.

The procedure may be required when the condition of the child or mother requires urgent delivery, or when labor is weak. Also, a puncture is a solution in some cases when the natural sequence of the birth process is disrupted. The membranes may be so strong that they do not tear and a puncture is required; another common reason for amniotomy during childbirth is the so-called “flat bladder”, when there is no fluid in its lower part and the membranes tighten around the baby’s head and interfere with its advancement and opening cervix.

However, it is not at all harmful to remember the indications for which this procedure is performed, so that if it is necessary, you can clearly understand what is happening.

Expert commentary

Indications for amniotomy:

induction of labor during post-term pregnancy;

weakness of labor;

, ;

“flat” amniotic sac (the membranes are stretched on the fetal head, preventing its movement through the birth canal);

complete opening of the uterine pharynx, if the fetal bladder has not opened on its own (dense membranes);

in case of multiple pregnancy, after the birth of the first fetus, an amniotomy of the second amniotic sac is performed;

suspicion of fetal hypoxia and premature placental abruption;

the condition of the pregnant woman does not allow further prolongation of pregnancy;

It is advisable to perform an amniotomy before labor anesthesia using the prolonged method. .

From the moment the integrity of the bladder is broken, there is no turning back - the clock counts, because the anhydrous period cannot last indefinitely (usually doctors recommend limiting the time period from the moment the bladder opens to the onset of labor to 10-12 hours, but this issue is resolved in each case individually).