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Amniotomy

  • Author: Nan G O'Connell, MD; Chief Editor: Christine Isaacs, MD  more...
 
Updated: Oct 26, 2014
 

Background

Amniotomy (also referred to as artificial rupture of membranes [AROM]) is the procedure by which the amniotic sac is deliberately ruptured so as to cause the release of amniotic fluid. Amniotomy is usually performed for the purpose of inducing or expediting labor or in anticipation of the placement of internal monitors (uterine pressure catheters or fetal scalp electrodes). It is typically done at the bedside in the labor and delivery suite.

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Indications and Contraindications

Amniotomy is indicated in the following situations:

  • When internal fetal or uterine monitoring is needed[1]
  • For induction of labor, usually in conjunction with an oxytocin infusion[2, 3, 4, 5, 6, 7]
  • For augmentation of labor, in that amniotomy leads to an increase in plasma prostaglandins[8] ; data on the effectiveness of labor augmentation are mixed[9, 10]

Amniotomy may be contraindicated in the following situations:

  • Known or suspected vasa previa
  • Any contraindications to vaginal delivery
  • Unengaged presenting part (although this obstacle may be overcome with the use of a controlled amniotomy or the application of fundal or suprapubic pressure)
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Contributor Information and Disclosures
Author

Nan G O'Connell, MD Assistant Professor, Department of Obstetrics and Gynecology, VCU Medical Center, Virginia Commonwealth University School of Medicine; Medical Director, Obstetrics and Gynecology Services, VCU Medical Center at Stony Point

Nan G O'Connell, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics

Disclosure: Nothing to disclose.

Coauthor(s)

Breanna L Walker, MD Resident Physician, Department of Obstetrics and Gynecology, Virginia Commonwealth University Health System

Disclosure: Nothing to disclose.

Specialty Editor Board

John G Pierce, Jr, MD Associate Professor, Departments of Obstetrics/Gynecology and Internal Medicine, Medical College of Virginia at Virginia Commonwealth University

John G Pierce, Jr, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, Christian Medical and Dental Associations, Medical Society of Virginia, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Christine Isaacs, MD Associate Professor, Department of Obstetrics and Gynecology, Division Head, General Obstetrics and Gynecology, Medical Director of Midwifery Services, Virginia Commonwealth University School of Medicine

Christine Isaacs, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.

References
  1. Cunningham, Levano, Bloom, Hauth, Rouse, Spong. Abnormalities of the Placenta, Umbilical Cord and Membranes. Williams Obstetrics. 23rd. United States: McGraw-Hill; 2010. Chapter 27.

  2. Nachum Z, Garmi G, Kadan Y, Zafran N, Shalev E, Salim R. Comparison between amniotomy, oxytocin or both for augmentation of labor in prolonged latent phase: a randomized controlled trial. Reprod Biol Endocrinol. 2010. 8:136. [Medline].

  3. Bricker L, Luckas M. Amniotomy alone for induction of labour. Cochrane Database Syst Rev. 2000. CD002862. [Medline].

  4. Cooley SM, Geary MP, O'Connell MP, McQuillan K, McParland P, Keane D. How effective is amniotomy as a means of induction of labour?. Ir J Med Sci. 2010 Sep. 179(3):381-3. [Medline].

  5. Cunningham, Lenevo, Bloom, Hauth, Rouse, Spong. Labor Induction. Williams Obstetrics. 23rd. United States: McGraw-Hill; 2010. Chapter 22.

  6. Howarth GR, Botha DJ. Amniotomy plus intravenous oxytocin for induction of labour. Cochrane Database Syst Rev. 2001. CD003250. [Medline].

  7. Selo-Ojeme DO, Pisal P, Lawal O, Rogers C, Shah A, Sinha S. A randomised controlled trial of amniotomy and immediate oxytocin infusion versus amniotomy and delayed oxytocin infusion for induction of labour at term. Arch Gynecol Obstet. 2009 Jun. 279(6):813-20. [Medline].

  8. Mitchell MD, Flint AP, Bibby J, Brunt J, Arnold JM, Anderson AB. Rapid increases in plasma prostaglandin concentrations after vaginal examination and amniotomy. Br Med J. 1977 Nov 5. 2(6096):1183-5. [Medline].

  9. Smyth RM, Alldred SK, Markham C. Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev. 2007. (4):CD006167. [Medline].

  10. Wei S, Wo BL, Xu H, Luo ZC, Roy C, Fraser WD. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev. 2009 Apr 15. CD006794. [Medline].

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