home Endocrinology How does the amniotic sac protect the baby? Amniotic sac. How it should be and how it happens

How does the amniotic sac protect the baby? Amniotic sac. How it should be and how it happens

4 Sep 2018

What is the amniotic sac and everything about it

The amniotic sac is where your baby lives for the entire nine months. It is protected from all kinds of germs and viruses. Therefore, many mothers do not understand why open it if the water breaks on its own during childbirth. Let's do a little consultation on this topic.

Opening the amniotic sac in medicine is most often called in one word - amniotomy. This is a medical term that doctors often use in practice.

There are several types of amniotomy.

1.Premature
2.Early
3.Late

Premature opening of the bladder occurs at different stages of pregnancy. The purpose of this action is to stimulate labor. In this way, doctors prevent all sorts of negative consequences that are likely to begin.

Medical indications

In order to carry out such actions, appropriate medical indications are required.

1. In the case when drug treatment does not produce results. In order not to sacrifice the health and life of the mother and child, doctors are forced to resort to such measures.

2.Chronic diseases of the mother. For example, serious problems with the heart, blood pressure, kidneys, diabetes.

3. When a woman is due to give birth, but there are no contractions. True, today such premises are used less and less. Because many experts are in favor of allowing the process to begin without outside interference.

4.Aging of the placenta. Most often, this happens when the expectant mother carries her baby to term.

5.As well as other reasons that may cause concern for the health of two people.

Options for the development of the amniotic sac

Early amniotomy is used already during labor. Here is a list of indications for when to use bladder puncture.

1.High water.
2. Inferiority of the bladder.
3.Weak labor activity.

If a girl has polyhydramnios, the uterus is constricted due to a huge amount of excess fluid. Due to weak contractions of the uterus, doctors are forced to puncture the amniotic sac. There are many reasons why a woman has polyhydramnios. These can be infectious diseases, inflammatory processes in the body and much more.

Low water levels are also a reason for amniotomy. When the volume of frontal waters is less than normal, the bubble stops performing its processes efficiently and at full strength. It takes on a flat shape, dangles sluggishly and is unable to help the uterus open.

If a woman cannot give birth for a long time, then by opening the bladder, labor speeds up. When the bladder is punctured, a substance called prostaglandin leaks out. It is this that activates uterine contractions and enhances its activity.

The last option, when you have to intervene and puncture the amniotic sac, is a delayed form.

This happens when the cervix has fulfilled its function and dilated, but the amniotic sac remains unchanged. As a result, labor is delayed. Due to its density or elasticity, the bubble does not open. At best, this interferes with the child's movement. At worst, it threatens the baby with asphyxia.

Is the amniotic sac punctured? When is amniotomy indicated? What exactly the procedure is and how it is carried out will be discussed in this article.

Amniotomy. What it is?

From women who have already been through childbirth, you can sometimes hear such an expression as “blister puncture.” If the young mother’s interlocutor is a pregnant woman, after this phrase her eyes express genuine horror.

The key word that frightens expectant mothers so much is “puncture,” because it immediately evokes an association with some kind of painful injection.

In fact, this is not true at all.

The medical term for puncturing or opening the amniotic sac is called amniotomy. This procedure is carried out directly in the maternity ward and only if there are serious indications for it.

It must be said right away that puncture of the bladder, just like its natural rupture, is an absolutely painless phenomenon. The fact is that the amniotic sac does not have nerve endings, so the woman feels practically nothing, except for the flow of warm amniotic fluid.

To understand why an amniotomy is sometimes required during childbirth, let's take a closer look at the birth process.

Amniotic sac. When should rupture of membranes occur?

It is believed that normally, they should begin with periodic contractions of the uterus - contractions. In the first stage of labor, an increase in the frequency and intensity of contractions contributes to the smoothing and opening of the cervix, and this in turn helps the baby move smoothly through the birth canal. But the amniotic sac also helps with proper dilatation of the cervix.

When the pressure in the uterus increases, it becomes very tense, causing the amniotic fluid to “drain” into the lower region, penetrate the cervix and promote the dilatation of the cervix.

In women who give birth for the first time, the dilation of the cervix occurs in the following sequence:

First, the internal os of the uterus opens;
Then the cervix becomes smoother and thinner;
Finally, the external cervical os opens.

In multiparous women, the external os may be open several days or even weeks before birth. And the immediate process of full disclosure occurs in parallel with the process of smoothing and thinning.

By the second stage of labor, as a rule, the cervix is fully dilated by 10-12 centimeters, opening the “road” for the baby. During the normal course of labor, it is during this period that the natural rupture of the membranes occurs, and the anterior amniotic fluid flows out.

Doctors call this small volume of amniotic fluid anterior because it is located in front of the presenting part of the fetus, most often in front of the head. As the baby moves further, the rest also pour out; the largest volume, of course, “comes out” immediately after the full birth of the child.

What happens if the membranes rupture before contractions occur?

Sometimes labor occurs “out of order,” and the onset of contractions is preceded by the release of amniotic fluid. Moreover, amniotic fluid can either leak slightly or pour out at the same time. Experts say that such a deviation from the norm occurs only in 12% of women in labor and refers to it with the term “premature rupture of amniotic fluid.” If the waters break already during the period of active, but not complete dilatation of the cervix, they speak of “early discharge.”

A woman cannot help but notice such a phenomenon; she either immediately observes a “leaked glass of water” or notices a wet spot on her underwear, which gradually increases in size.

The color and smell of the amniotic fluid matters; usually the amniotic fluid is completely clear or slightly pinkish. But if green, black or brown color is mixed with it, this means that they contain mecconium - the original feces. This situation requires acceleration of the birth process, since the baby experiences oxygen starvation. An admixture of yellow color may indicate the presence of Rh conflict, which also requires emergency help.

If the waters break outside the maternity ward, you need to immediately go to the hospital, and you need to know the exact time of their release, and tell the medical staff about it upon arrival.

If a woman’s body is ready for childbirth, contractions will begin literally immediately after the bladder bursts, or in the next few hours. But sometimes labor develops very slowly or is completely absent.

The fact that the baby is no longer protected by the membranes can negatively affect his health; now he is open to infection. Also, premature rupture of amniotic fluid can cause fetal hypoxia and delay the labor process as a whole.

Amniotomy. Indications for opening the amniotic sac

Weak labor.

Characterized by the fact that they are present, but they are not expressive and short-lived, and their frequency is very rare.

Irregular and completely ineffective contractions that do not dilate the cervix for several days.

In medicine, this phenomenon is called the preliminary period.

There are physiological (normal) preliminary period (NPP) and pathological (PPP).

NPP is characterized by prolapse of the pregnant woman’s abdomen, irregular frequency of cramping pain in the lower abdomen, large intervals between them (the so-called “false” contractions), a “mature” cervix, and the passage of a mucous plug.

Preparatory contractions can last several hours or even days, stop and resume after a day or more. They do not deprive a woman of sleep and peace. During this period, the woman is observed.

Pathological preliminary period (PPP) - uterine contractions (preparatory contractions) are painful, occur at any time of the day, and are irregular.

The duration of PPP can range from 24 to 240 hours, depriving a woman of sleep and rest.
Cervical ripening does not occur; the cervix is “immature” and not ready for childbirth.
Part of the fetus is located high relative to the entrance to the woman’s pelvis.
The frequency of contractions does not increase, the strength does not increase.

Treatment with PPP is necessary, which consists of accelerating the “ripening” of the cervix, eliminating painful contractions of the uterus, and achieving labor. The maximum duration of treatment is 3-5 days. When the cervix reaches “maturity,” an early amniotomy is performed.

It is impossible to open the amniotic sac when the cervix is immature!

Post-term pregnancy.

We are talking about actual postmaturity of the fetus, when irreversible processes begin in the placenta that no longer allow the baby to be supplied with oxygen and all the necessary substances. The situation is dangerous due to the development of intrauterine fetal hypoxia.

Severe preeclampsia.

This is one of the most dangerous complications of pregnancy, causing a malfunction of many internal organs and systems of the mother. A woman’s blood pressure rises, a pathological increase in weight occurs due to swelling of the whole body, protein appears in the urine - kidney function is disrupted.

In the most severe cases, convulsions occur and coma occurs. Of course, such complications can also affect the baby’s health. In this case, urgent delivery is necessary, so puncture of the bladder is one of the first procedures that can speed up the birth process.

Mother's illnesses.

They are often associated with vascular dysfunction, for example, hypertension, heart or kidney problems. Chronic lung diseases, etc. are also dangerous.

During an amniotomy, the size of the uterus decreases as most of the amniotic fluid is removed. Accordingly, the uterus itself ceases to exert increased pressure on nearby vessels, which generally improves blood circulation and reduces pressure.

Rhesus conflict.

Since pregnancy with such a diagnosis is considered problematic, amniotomy can be used as one of the methods of stimulating labor.

It is carried out rarely, more often when signs of hemolytic disease of the fetus appear, which is confirmed by the results of amniocentesis and when antibodies increase in the blood of the pregnant woman.

There is a possibility that with this location of the placenta, labor will cause its rejection. Of course, this is very dangerous for the fetus, since it stops receiving oxygen.

When the amniotic sac is opened, amniotic fluid is released and the fetal head presses against the placenta. Thus, premature detachment does not occur.

The puncture of the bladder is carried out in order to reduce the amount of amniotic fluid, which causes overstretching of the walls of the uterus and may be the real cause of weakness in labor.

Also, this procedure can help avoid prolapse of umbilical cord loops and small parts of the fetal body if the amniotic fluid were to recede on its own.

The structure of the fetal membrane is too dense.

Sometimes the amniotic sac does not rupture at all, even when the cervix is fully dilated. This can happen if the membranes are too tight or elastic, sometimes due to too little anterior fluid.

Unfortunately, such births can become quite difficult, since the baby, “wrapped” in the fetal membranes, moves through the birth canal quite slowly. In addition, the risk of premature placental abruption and intrauterine hypoxia increases if the baby takes a breath immediately after birth.

In the old days, a child who went through such a birth was called “born in a shirt,” and this was considered a miracle. In fact, such babies were truly lucky, since for them the risk of death was quite high.

Flat amniotic sac.

This is the case when the ability of the fetal membranes to stretch can turn out not for the better. Most often this happens when there is little water, and there may not be any frontal water at all, or their amount may be very small.

It turns out that due to the lack of anterior waters, the membrane of the fetus is stretched on its head. As a result, the likelihood of abnormal labor and premature placental abruption increases.

Amniotomy cannot be done if the child is positioned high, there is a risk of umbilical cord loops falling out, and this causes very serious consequences. Early, untimely opening of the membranes can lead to partial compression of the umbilical cord, fetal hypoxia and the need for an urgent cesarean section.

Multiple pregnancy.

Timely opening of the membranes after the birth of the first fetus helps prevent premature abruption of the placenta, both the born and the unborn second fetus, or their common placenta.

Premature placental abruption can occur due to a rapid decrease in the volume of the uterus and a decrease in intrauterine pressure after the birth of the first fetus.

Opening of the amniotic sac when the cervix is dilated by 6-8 cm

In this situation, the amniotic sac is no longer needed, and its presence, on the contrary, can lead to intrauterine fetal hypoxia.

Amniotomy. How is the procedure performed?

A puncture of the amniotic sac is performed by an obstetrician-gynecologist during a vaginal examination. In order to open the membranes, a special sterile medical instrument is used that resembles a long hook (branches of bullet forceps). With this instrument, the doctor picks up and pierces the membranes.

The puncture itself is carried out at the peak of uterine contraction, so that the membranes are stretched as much as possible. This prevents injury (scratching) to the presenting part of the fetus, the baby’s scalp. The doctor expands the hole obtained after the puncture manually, gradually inserts the index finger into it, and then the middle finger. This allows the amniotic fluid to flow out gradually.

Let us remind you once again that this procedure is absolutely painless, since the amniotic sac is devoid of any nerve receptors or endings. The vaginal examination itself may be unpleasant for a woman, but she does not experience any pain during the puncture.

It is clear that opening the amniotic sac in each specific case must be justified, since it performs very important functions:

Serves to protect the fetus from infections;
It is a kind of “airbag” for the baby from external damage;
Creates conditions for fetal movement;
Promotes fetal lung development.

It turns out that during the period of maximum intense contractions, the baby’s body, protected by the fetal membranes, does not experience strong pressure, and the head does not change its anatomical shape when passing through the birth canal. If there are no membranes, all these unpleasant sensations intensify, and the head becomes deformed under the influence of strong pressure. On the other hand, the same thing happens at the moment of natural rupture of the membranes.

The amniotic sac softens the birth itself, makes it less painful, and the process of cervical dilatation smoother. Some women claim that the puncture of the bladder gave them a feeling of gross interference in the birth process, since contractions proceeding at a normal pace, after opening the bladder, suddenly became too painful and intense.

In any case, routine amniotomy is unwarranted. The specialist must clearly justify the reason why there is a need for this procedure.

Thank you

Amniotomy is a type of obstetric aid necessary to ensure the optimal course of labor. The essence of this manual is to violate the integrity of the amniotic sac and release amniotic fluid.

Amniotomy - what is it?

At its core, amniotomy is the opening of the membranes of the membranes that surround the baby in the womb and keep amniotic fluid from spilling out. You can open the amniotic sac in various ways - cut or pierce with special medical instruments, or simply tear it apart with your fingers. The manipulation of opening the membranes can be thought of as cutting or tearing a well-inflated balloon. This procedure is completely painless, since there are no pain receptors in the membranes of the bladder.

Amniotomy is now a standard obstetric benefit provided to pregnant or laboring women by a physician or midwife. Amniotomy leads to the release of amniotic fluid from the uterus and the release of numerous biologically active substances.

Amniotomy is a painless procedure, absolutely safe for the mother and fetus if performed according to indications. However, despite the safety and simplicity of this obstetric manipulation, it is an interference in the natural course of labor. Therefore, amniotomy should be performed only if it will help eliminate any problems during childbirth. There is simply no need to perform an amniotomy at will, since this simple manipulation causes pronounced effects, such as:

Strengthening labor and contractile activity of the uterus, due to which the dilation of the cervix accelerates;
Increasing the intensity of contractions and shortening the intervals between them;
Stopping labor bleeding with placenta previa;
Prevention of loss of small parts (arms and legs) of the fetus during childbirth;
Decreased blood pressure in a woman in labor.

Typically, amniotomy is performed with the aim of inducing labor or enhancing labor, and the mechanism for the development of these effects of opening the amniotic sac is not clear. Doctors and scientists suggest that after the opening of the amniotic sac, the baby’s head is more closely adjacent to the lower segment of the uterus and more irritates its receptor apparatus. Such mechanical irritation of the birth canal by the fetal head indirectly enhances the production of oxytocin and prostaglandins, which stimulate labor in a woman. Currently, doctors believe that amniotomy in combination with drug methods of labor stimulation is a very effective way to speed up labor. Thanks to amniotomy, the time for complete dilatation of the cervix is reduced by about a third. If the amniotic sac was opened before labor began, amniotomy may trigger spontaneous onset of labor.

Amniotomy is a safe procedure that does not negatively affect the condition of the fetus. However, even this procedure has complications, such as prolapse of an arm or leg when amniotic fluid is released quickly, or bleeding when a large blood vessel is damaged, some of which runs along the surface of the bladder.

Conditions for amniotomy

Due to the possibility of complications, amniotomy can only be performed under the following conditions:

Head presentation of the fetus;
Singleton pregnancy;
Full-term pregnancy (at least 38 - 39 weeks);
Fruit weight no more than 3000 g;
Correct position and insertion of the head into the entrance to the pelvis;
Readiness of the birth canal (the cervix is smoothed, shortened, and the obstetrician’s finger misses during examination);
Cervical maturity of at least 6 points on the Bishop scale;
Normal pelvic size;
Lack of scars on the uterus after various operations on the organ (previous cesarean sections, removal of fibroids, etc.).

If at least one of the above conditions is not met, then amniotomy cannot be performed, since this may provoke negative consequences for the fetus or mother.

Amniotomy is used quite widely, and the duration of use of this benefit goes back more than one millennium, since women have given birth to children throughout the history of mankind, and opening the amniotic sac is a simple and accessible manipulation. Thanks to numerous and long-term observations of the results of amniotomy, the indications and contraindications, as well as the timing of this obstetric manipulation, have now been clearly established.

Amniotomy - indications for manipulation

All indications for amniotomy can be divided into two types:
1. Indications for labor stimulation;
2. Indications for childbirth.

Indications for labor stimulation are situations in which it is necessary to start labor against the background of its complete absence. Indications for amniotomy during childbirth include a list of situations when, in the presence of labor, it is necessary to open the amniotic sac.

So, for labor stimulation, amniotomy is indicated in the following cases:

Preeclampsia. In severe cases of gestosis, when continuation of pregnancy is dangerous for both the mother and the fetus, induction of labor is indicated for the purpose of urgent delivery. In this case, amniotomy is performed to induce labor;
Post-term pregnancy;
Premature abruption of the normally located placenta (PONRP);
Death of the fetus in the womb;
Severe chronic diseases of the mother (for example, diabetes mellitus, arterial hypertension, renal failure, pathology of the lungs and heart, etc.), which make further pregnancy impossible due to the high risk of death of both the mother and the fetus;
Pathological preliminary period, when a woman experiences preparatory contractions for several days in a row that do not develop into regular, normal labor. In this situation, the woman gets tired, and the child suffers from hypoxia. The doctor opens the amniotic sac, since amniotomy in 90% of cases will lead to the development of regular labor and the birth of a normal, healthy baby within the next 12 to 18 hours;
Rhesus conflict pregnancy. When the titer of anti-Rhesus antibodies in the mother’s blood increases, it is necessary to urgently induce labor, since further continuation of pregnancy will lead to worsening of the hemolytic disease of the fetus and a deterioration in its condition. In such a situation, amniotomy is a way to induce labor.

If there are any of the listed indications, then the opening of the amniotic sac is not always performed, but only if the conditions for amniotomy are met (mature cervix, absence of scars on the uterus, cephalic presentation of the fetus, normal pelvic dimensions, etc.).

The above-described indications for amniotomy are, in fact, conditions in which it is necessary to perform labor stimulation, that is, to induce labor artificially, without waiting for its natural onset. Amniotomy in a large number of cases within 12 hours leads to the development of regular labor, that is, it is an excellent labor-stimulating agent. Typically, to induce labor, an amniotomy is performed and a wait of 12 hours is performed. If after 12 hours labor has not developed, then labor is stimulated with medications (Oxytocin, Prostin, etc.).

If labor has already begun, then the following conditions are indications for amniotomy:

In addition to these indications, amniotomy can be performed during any labor to speed up the dilatation of the cervix. In this case, amniotomy is performed when the cervix is dilated by 4–6 cm, not earlier.

Amniotomy technique - a technique for opening the membranes of the fetal bladder

Half an hour before the planned amniotomy, the woman is administered intravenously or given antispasmodic drugs in tablet form, such as No-shpa, Papaverine, Drotaverine, etc.

To perform an amniotomy, the woman lies down on the obstetric couch and places her legs spread apart on the holders. The doctor puts on a sterile glove, inserts his fingers into the vagina and leaves them there. With the second hand, the doctor takes a small jaw that looks like a hook, which can be used to hook the membrane of the amniotic sac, pull and rupture it. The doctor inserts the branch along the finger of the second hand left in the vagina. At the height of the contraction, when the membrane of the amniotic sac is tense and bulges along the vagina, the doctor carefully hooks it, makes a puncture, then gently pulls it towards himself, thereby making a small hole in it. Then the instrument is removed from the vagina, and a finger is inserted into the resulting hole in the amniotic sac. With a finger, the doctor carefully expands the hole, slowly releasing amniotic fluid. After amniotomy, the woman must lie down for at least 30 minutes, during which the fetal heartbeat should be monitored using CTG.

You should not release amniotic fluid in a stream, greatly and sharply expanding the lumen in the membrane of the bladder, as this can provoke the loss of umbilical cord loops or small parts of the fetus (legs or arms).

Amniotomy during childbirth - types and purposes

Depending on the moment and period of labor the amniotomy was performed, it is divided into four types:
1. Premature or antenatal amniotomy, which was performed even before the onset of labor. Premature amniotomy is always performed with the aim of initiating labor if it is necessary to carry out labor immediately, without waiting for its natural onset;
2. Early amniotomy, which is performed against the background of regular contractions when the cervix is dilated less than 6 - 7 cm. This amniotomy is performed according to indications when the amniotic sac interferes with the normal course of labor (see the section “indications for amniotomy”). In addition, early amniotomy can be performed to speed up cervical dilatation;
3. Timely amniotomy, which is produced when the cervix is dilated by 8–10 cm against the background of regular labor. In such a situation, amniotomy is performed in order to accelerate the full dilatation of the cervix. The procedure for opening the amniotic sac allows you to speed up the dilatation of the cervix by 30%;
4. Delayed amniotomy, which is performed when the cervix is fully dilated against the background of normal labor, when the fetal head has already descended into the pelvis and is expelled. If an amniotomy is not performed at this moment, the child will be born in the amniotic sac or, as people say, “in a shirt.” However, this is fraught with severe postpartum bleeding in the mother or the baby suffocating, so it is recommended to perform an amniotomy before the baby is born.

Currently, all types of amniotomy are used in obstetrics, depending on the specific situation, the condition of the woman in labor and the fetus. Moreover, it cannot be said that only one type of amniotomy is correct, since in different situations it is necessary to open the amniotic sac at different times and periods of labor. In other words, for each type of amniotomy there are indications and conditions when this manipulation is necessary.

Amniotomy - contraindications for production

Amniotomy, despite the simplicity and usefulness of manipulation in many cases, may be contraindicated in certain situations. The main contraindications to amniotomy are the following:

Exacerbation of genital herpes;
Incorrect position of the fetus (pelvic, leg presentation, oblique or transverse position);
Placenta previa;
Presentation of umbilical cord loops.

In addition to the above, contraindications for amniotomy include all situations where a woman is prohibited from giving birth naturally (through the vagina). Currently, the following conditions are contraindications to vaginal birth and, accordingly, amniotomy:

Complete placenta previa, diagnosed by ultrasound during pregnancy;
Incompetent scar on the uterus. Diagnosed if less than three years have passed since any previous operation on the uterus (cesarean section, removal of fibroids, rudimentary horn, excision of the angle of the uterus, etc.);
Two or more scars on the uterus;
A condition of the birth canal that prevents normal childbirth (anatomical narrowing of the pelvis II, III, IV degrees, deformation of the pelvic bones, tumors of the uterus, ovaries, bladder or other pelvic organs);
Severe symphysitis (inflammation of the tissues of the symphysis pubis);
Large fetus (estimated body weight more than 4500 g);
Cicatricial deformities of the cervix or vagina;
Previous history of plastic surgery on the cervix and vagina, suturing of genitourinary or intestinal fistulas;
The presence of third-degree perineal ruptures during previous births;
Breech presentation of the fetus with a body weight of more than 3600 - 3800 g or less than 2000 g;
Gluteal presentation of the fetus;
III degree extension of the head according to ultrasound data;
Breech presentation of the first fetus during multiple pregnancy;
Triplets;
Conjoined twins;
Monochorionic, monoamniotic twins (two fetuses are in the same bladder and are fed from one placenta);
The presence of a malignant tumor in any organ;
Stage III fetal growth retardation;
Myopia (myopia) of a high degree with changes in the fundus;
Previous kidney transplant;
Death or disability of a child during a previous birth;
Pregnancy resulting from IVF;
Premature abruption of a normally located placenta;
Acute fetal hypoxia according to CTG data.

As you can see, the main contraindications to amniotomy coincide with those for vaginal birth, the range of which is quite wide. Therefore, if for some reason a woman cannot give birth naturally, then amniotomy at any period is contraindicated for her. If childbirth through natural means is allowed, then an amniotomy can be performed for this woman.

Amniotomy - complications

Complications of amniotomy are caused by a violation of the integrity of the blood vessels and changes in the condition of the fetus. Possible complications of amniotomy include the following conditions:

Bleeding that develops if, during the opening of the bladder, a large blood vessel passing along the surface of the fetal membrane is touched;
Loss of umbilical cord loops or small parts of the fetus (arms or legs);
Deterioration in the condition of the fetus due to a sharp change in the conditions of its existence after removal of amniotic fluid;
Weakness or violent labor;
Fetal infection.

The listed complications of amniotomy develop very rarely; moreover, correct and timely implementation of the procedure allows them to be prevented in most cases.

Amniotomy - reviews

According to reviews from women, amniotomy leads to increased contractions, which become painful, prolonged and severe. However, along with the intensification of contractions, as most women in labor also note, amniotomy accelerated their labor. Depending on the period in which the amniotomy was performed, women noted the onset of labor after 3–6 hours or after 10–30 minutes.

Regarding pain when puncturing the amniotic sac, women believe that they are insignificant or completely absent. In rare cases, women have experienced pain or discomfort during the puncture of the amniotic sac.

In the vast majority of cases, amniotomy is performed without the prior consent of the woman in labor and without explaining the need for this manipulation. Some note that this fact was even hidden from them by hiding the instrument behind their backs. However, there are cases when the doctor explained in detail the need for manipulation, as it should be according to the instructions and protocols for labor management.

In general, women’s attitude towards amniotomy is positive, since they did not notice any pronounced negative consequences of this procedure. One of the main disadvantages of the manipulation of the mother is the scratches on the baby’s head left by the instrument.

Before use, you should consult a specialist.

As you know, during intrauterine development, the unborn baby is surrounded by membranes. These include the amnion, smooth chorion and part of the decidua (endometrium, which undergoes changes during pregnancy). All of these membranes, together with the placenta, form the amniotic sac.

Many expectant mothers think that the placenta and amniotic sac are one and the same. Actually this is not true. - an independent formation that provides nutrients and oxygen to the fetus. It is through it that the fetus communicates with the mother’s body.

What is the amniotic sac?

The development of the listed fetal membranes begins immediately after the process. Thus, the amnion is a thin translucent membrane, which essentially consists of connective and epithelial tissue.

The smooth chorion is located directly between the amnion and the decidua. It contains a large number of blood vessels.

The decidua is located between the ovum and the myometrium.

The main parameters of the fetal bladder are its density and size, which changes over the weeks of pregnancy. So, on the 30th day, the diameter of the fetal bladder is 1 mm and then increases by 1 mm per day.

What are the functions of the amniotic sac?

Having said what the amniotic sac looks like, let’s figure out what its main functions are. The main ones are.

In this article:

When a gynecologist tells a pregnant woman that she has prolapsed membranes, this indicates a direct threat of miscarriage, especially in the absence of appropriate treatment.

The period of waiting for a baby is not easy for the female body, because all its strength is concentrated on preserving and bearing a full-fledged healthy child. A large load falls on the cervix: the retention of the fetus inside the mother’s body depends on the density of its compression.

What is prolapsed membranes?

By this term, doctors mean isthmic-cervical insufficiency (ICI). In this condition, weakness of the cervix and isthmus of the uterus is observed, as a result of which spontaneous pregnancy may occur, starting in the second trimester of pregnancy.

The cervical canal is not able to be in good shape and be tightly compressed, so its walls relax, and the amniotic sac, under the weight of the child, sinks into the cervix, which leads to its infection and opening. Such actions lead to rupture of the membranes and termination of pregnancy.

Causes

When the amniotic sac prolapses, the isthmus and cervix fail to cope with their main task - tightly closing the path to the uterine cavity and securely holding the growing baby in the mother's womb.

There are certain reasons for the descent of the membranes observed with isthmic-cervical insufficiency:

congenital anomalies of the female reproductive system;
hormonal imbalance in the body of a pregnant woman (insufficient production of progesterone and excessive production of male sex hormones);
multiple pregnancy;
cicatricial changes on the uterus resulting from previous, as well as traumatic injuries.

The pathology can be identified only in the second trimester of pregnancy, when the child begins to grow rapidly, which leads to increased pressure on the cervix, which cannot reliably hold the fetus in the woman’s body.

Symptoms

The danger of isthmic-cervical insufficiency lies in the fact that it has no precursors that would indicate the likelihood of developing pathology. Therefore, prolapse of the membranes always occurs unexpectedly. If you pay close attention to your health, you can notice the initial symptoms of this condition and take measures to maintain pregnancy.

The expectant mother should urgently seek medical help if she discovers the following signs:

leakage of amniotic fluid;
atypical urination;
feeling of discomfort in the vagina.

It is impossible to predict in advance that a woman will experience bladder prolapse, since there are no subjective sensations before the moment of conception and in the first three months of pregnancy.

Diagnosis of isthmic-cervical insufficiency is made during an instrumental gynecological examination using speculum, as well as during palpation of the vagina. At the initial stages, softening and shortening of the cervix occurs, later a slight dilatation of the cervix, about 2 cm, and prolapse of the amniotic sac are detected.

Treatment

The choice of treatment method for ICI depends on several factors:

period of detection of insufficiency of the cervix and isthmus of the uterus;
whether there is a history of self-abortion due to shortening and expansion of the cervical canal;
reasons that led to ICN.

When a woman has already experienced miscarriage for this reason, it is possible to undergo cervical plastic surgery at the stage of pregnancy planning. The effectiveness of the medical procedures performed can be assessed no earlier than six months later - it is during this period that doctors recommend refraining from subsequent conception.

Conservative treatment is prescribed to the patient in case of early detection of prolapsed membranes caused by hormonal imbalance, especially an excess of male hormones. Medicines make it possible to correct endocrine disorders. If after 10-14 days the cervix has stabilized and there are no prerequisites for its further expansion, then therapy is limited only to medications.

With ICN, they resort to an installation that tightly closes the cervix and prevents it from opening. The product is a strong wide ring that is fixed at the entrance to the uterus. The pessary helps to redistribute the load exerted on the cervical canal by the growing fetus, supports the muscles of the perineum and prevents the prolapse of the amniotic sac. If prolapse has already occurred, then the ring cannot be placed.

Compared to surgical treatment, this technique has several advantages:

ease of insertion and removal;
installation can be performed both in a hospital setting and on an outpatient basis;
no need for anesthesia;
Fixation of the pessary is allowed after the 25th week of pregnancy.

When medication does not help stop the dilatation of the cervix, or ICI is observed due to a previous traumatic factor, surgical intervention is required to maintain pregnancy.

Sutures are placed on the cervix between 13 and 26 weeks of pregnancy, and they are removed no earlier than 38 weeks. After this, the uterus independently opens and shortens, opening the birth canal.

Suturing the cervix is the best option to prevent the threat of miscarriage when the membranes prolapse. This method is low-traumatic, easy to perform, and also does not harm the health of the mother and child.

The operation is performed only in a hospital. Before the procedure, a full examination of the pregnant woman is performed, and the external genitalia and vagina are sanitized using antiseptic solutions. After the procedure, the expectant mother will have to visit the doctor weekly for follow-up examinations.

If the amniotic sac descends into the cervical canal, additional correction of the sutures is required. After reconstruction, the woman must follow the doctor’s orders, stay in bed and take prescribed medications.

Flat amniotic sac

This pathology is also called oligohydramnios.

A flat amniotic sac is observed due to some complications of pregnancy, which are caused by various reasons:

infection of mother or child;
deficiency of nutrients and water;
vitamin deficiency.

During the natural course of pregnancy, between the baby's head and the membranes there is a free space filled with amniotic fluid. If there is a tight tension over the baby’s upper body, then doctors diagnose “flat amniotic sac.”

Puncture

Amniotomy is performed in situations where there is dilatation of the cervix, but spontaneous discharge of amniotic fluid has not occurred. The purpose of the procedure is to stimulate the onset of natural labor if the woman feels the onset, but they do not lead to shortening and expansion of the cervical canal.

There are four types of amniotomy:

premature – before the onset of labor;
early – from the moment contractions begin until the cervix dilates by 3 fingers;
timely - performed between 7-10 cm of dilation;
belated - performed after full expansion, when the bubble has not burst on its own.

Peeling

This procedure is performed when a woman carries her pregnancy to term. Detachment allows you to stimulate the onset of labor. The gynecologist manually separates the bladder from the cervix, which promotes the synthesis of prostaglandins, which have a relaxing effect on the cervical canal.

When performing the procedure, the doctor must carry out his actions as carefully as possible so as not to damage the membranes.

Prevention of pathologies of the fetal bladder

It is impossible to completely prevent prolapse of the amniotic sac, but you can reduce the risk of developing isthmic-cervical insufficiency by following simple recommendations:

carry out timely treatment of hormonal dysfunctions;
During pregnancy, avoid heavy lifting and heavy physical work.

If ICI is diagnosed, timely detection of the problem will prevent prolapse and rupture of the amniotic sac, and the use of modern treatment methods increases the chances of a successful pregnancy outcome by 2-3 times.