Physiological Adaptation Q 134
A patient in labor and delivery has just received an amniotomy. Which of the following is correct? Select all that apply.
A. Frequent checks for cervical dilation will be needed after the procedure.
B. Contractions may rapidly become stronger and closer together after the procedure.
C. The FHR (fetal heart rate) will be followed closely after the procedure due to the possibility of cord compression.
D. The procedure is usually painless and is followed by a gush of amniotic fluid.
E. The procedure is without pain.
Correct Answer: B, C, D & E.
Uterine contractions typically become stronger and occur more closely together following amniotomy. The FHR is assessed immediately after the procedure and followed closely to detect changes that may indicate cord compression. The procedure itself is painless and results in the quick expulsion of amniotic fluid.
Option A: Following amniotomy, cervical checks are minimized because of the risk of infection. Amniotomy is easily performed with the use of specially designed hooks intended to grab and tear the amniotic membrane. The two most commonly used devices are (1) an approximately 10-inch rod with a hook on the end of the rod or (2) a finger cot with a hook on the end of the cot. With either device, the practitioner first assesses cervical dilation through the performance of a sterile digital exam.
Option B: It is commonly felt that relieving the amniotic sac of amniotic fluid induces uterine contraction activity, increases the strength of contractions, and may augment labor by allowing direct pressure from the fetal scalp on the uterine cervix which may assist in dilating the cervix.
Option C: In the case of an unengaged fetal head, rupture of membranes may allow for the umbilical cord to precede the fetal head when the release of amniotic fluid occurs. This will allow the fetal head to compress the section of umbilical cord preceding the head, generally leading to fetal bradycardia and necessitating emergency cesarean section. This complication should be an easily avoidable, iatrogenic cause of emergency delivery.
Option D: The nurse plays a vital role during the procedure in monitoring the mother as well as the fetus, she also notes the color of the draining amniotic fluid and documents the findings in the medical chart. After the procedure, she assesses the maternal temperature every two hours and watches out for any signs of infection. The nurse also monitors the fetal heart rate via continuous electronic fetal monitoring and communicates the findings to the provider.
Option E: Pain is not associated with amniotomy. Practitioners have believed that artificial rupture of membranes either can assist in inducing labor or augmenting spontaneous labor. It is commonly felt that relieving the amniotic sac of amniotic fluid induces uterine contraction activity, increases the strength of contractions, and may augment labor by allowing direct pressure from the fetal scalp on the uterine cervix which may assist in dilating the cervix.