Amniotomy (Artificial Rupture of Membranes)

1. TITLE:

Amniotomy (Artificial Rupture of Membranes)

2. PURPOSE:

1. To ensure safe practice for rupture of the amniotic membranes.

2. To induce labour following administration of Prostin pessaries or gel when cervix is  favourable.

3. To induce labour.

4. To augment labour.

5. To apply a fetal scalp electrode (FSE).

6. To expedite delivery of the second twin following stabilization of the lie.

7. Prior to instrumental delivery.

3. CONDITION/ APPLICABILITY:

This policy applies to all OB Doctors.

4. DEFINITION:

Artificial rupture of membranes (AROM), also known as an amniotomy, may be performed by an obstetrician to induce or accelerate labor. The membranes may be ruptured using a specialized tool, such as an amnion hook or amnion indicator, or they may be ruptured by the examiner's finger. 

5. POLICY:

1. The OB doctor will perform an ARM.

2. An ARM will normally be performed on patients with normal term pregnancies in active labour.

3. An ARM for induction purposes may be performed by a midwife on the written instructions of an obstetrician.

4. An ARM for non-engaged presenting part (controlled) sdould by performed by the Obsetrician.

5. Verbal consent must be obtained from the patient prior to the procedure

6. PROCEDURE:

1. Explain the procedure to patient, obtain verbal consent and start CTG.

2. Ensure privacy,Perform abdominal palpation to confirm presentation and engagement of presenting part.

3. lithotomy position- Place patient knees elevated toward abdomen, legs abducted while feet on bed.

4. Wash hands, Open pack, Don sterile gloves.

5. Using sterile water, wash external genitalia. 

6. Perform vaginal examination using aseptic technique.

7. Insert index and middle fingers into the cervix.  

8. Guide amino hook through the cervix between the two fingers and rupture membranes by a sharp upward motion of amnion hook.

9. Slowly allow drainage of amniotic fluid.

10. Note color and quantity of amniotic fluid. 

11. Following procedure, dry patient’s vulva and apply clean sanitary pad.

12. Wash hands, Continue Cardiotocograph (CTG).

13. Dispose of equipment in appropriate manner.

14. Document- record the following in the patient’s notes and Partogram and on CTG paper.

1. Date, time and indication for ARM.

2. Position and degree of cervical effacement.

3. Cervical dilatation

4. ARM performed

5. Colour and amount of amniotic fluid.

7. RESPONSIBILITY:

It is the responsibility of the Consultant, Specialist and Resident.

8. FORMS/ EQUIPMENT:

1. Sterile gloves

2. Sterile lubricant (clear)

3. Amniotomy hook or scalp electrode

4. Electronic fetal monitor

9. REFERENCE:

Lab Guidelines and Standards, Journal of Medical Screening, Volume 16, Number 3, pg. 119-123, 2008.

10. REVISION

11. APPROVALS: