Premature rupture of membranes at different stages of pregnancy

Almost the entire period of bearing a baby, the expectant mother worries about the condition of the baby. Of course, many of the experiences are far-fetched, but some are real. A woman suffers from toxicosis, constantly puts her hand to her tummy to find out whether the baby is moving or not, anxiously awaits test results, monitors the tone of the uterus, anxiously awaits an ultrasound to look at the unborn baby and hear the cherished words that the baby is developing Fine.

Among the possible reasons for concern, there is a rather significant one, however, alas, few women know about it. Based on statistics from the Obstetrics Center, about 20% of all cases of baby loss occur due to premature rupture of the membranes.

However, there is still a chance to diagnose and prevent this threat at an early stage. Rupture of the amniotic sac is not a death sentence, and the baby can continue to develop normally.

What is prolapsed membranes?

By this term, doctors mean isthmic-cervical insufficiency (ICI). With this condition, there is weakness of the cervix and isthmus of the uterus, as a result of which spontaneous miscarriage can 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.

Complications of amniotomy

As with any, even the most harmless medical procedure, complications are possible with amniotomy, but in this case they are extremely rare.

Possible injury to the vessels of the fetal bladder and bleeding. There may be loss of umbilical cord loops. These complications are possible if the amniotomy is performed before the head is pressed against the entrance to the pelvis. The pressed head prevents the umbilical cord from falling out and avoids bleeding, since the vessels are also pressed. In addition, after an amniotomy, a woman is recommended to lie down for half an hour.

With polyhydramnios, it is necessary to control the rate of outflow of water, since with a rapid and sudden outflow, an arm or leg may fall out. Therefore, in cases of polyhydramnios, they first make a small hole and slowly release the water.

There is no need to be afraid of an amniotomy performed according to indications.

This procedure is performed frequently, so the doctor is “experienced” with it, and complications are extremely rare. Of all the stimulation methods, amniotomy is considered the safest method; opening the amniotic sac does not affect the child’s condition in any way. In addition, there are statistics that confirm that after amniotomy began to be widely used, complications during childbirth decreased. But, of course, this does not mean that it should always be used by everyone.

Fetal fluid helps the unborn baby feel comfortable in the womb, providing not only protection, but also nutrition. When fluid becomes insufficient, a flat bladder is diagnosed before childbirth, which is considered a serious pathology.

As soon as the embryo attaches to the endometrium of the uterus, it begins to grow a membrane, which is filled with nutritious fluid (the baby seems to float in it). In a normal pregnancy, the amount of amniotic fluid is 200 ml.

What is a flat bladder before childbirth?

When the volume of fluid becomes less than normal, the membrane sticks to the fetal head and becomes stretched (hence the name of the pathology). The child not only does not receive enough nutrients, there is a lack of air. If in the early stages of pregnancy this is not dangerous, then a flat amniotic sac during childbirth can cause asphyxia.

When there is enough fluid, the birth of a child occurs naturally, the baby's place bursts under pressure, the water flows out, and the baby is born comfortably. A flat bladder complicates childbirth, as it becomes difficult for the fetus to put pressure on the cervical canal. This slows down the process and causes complications.

In some cases, the pathology provokes placental abruption, which leads to premature birth and death of the child. Pain in the lower abdomen and constant restlessness of the fetus indicate a lack of amniotic fluid.

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;
• scar changes on the uterus resulting from previous surgical interventions, as well as due to 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.

Actions when water breaks

• Call an ambulance. • After the release of fetal fluid, the woman in labor needs to change her underwear. You should not wash it, as the likelihood of infection of the birth canal increases. • Pack your things for the hospital, don’t forget the necessary documents. • During contractions, it is recommended to perform breathing exercises to relieve paroxysmal pain.

• Walking for at least 60 minutes. • Moderate physical activity. • Nipple stimulation. • Sexual intercourse. • A small amount of fresh pineapple. After eating the fruit, prostaglandins are produced, which prepare the body for childbirth. • Cookies that stimulate labor. You can buy this dish at the pharmacy or prepare it yourself.

Thus, the discharge of fetal fluid is indicated by copious sputum in the perineum. After this symptom occurs, it is necessary to transport the woman in labor to the hospital or, in the event of a pathological development of events, call an ambulance. Doctors will assess the situation and determine the most appropriate option for managing the birth, taking into account the condition of the mother and child.

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 amniotic sac 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.

What can premature rupture of membranes lead to?

This pathology causes premature birth in 30-40% of cases and poses a particular danger to the fetus: there is a high risk of complications (hypoxia, pneumonia, sepsis, etc.), the severity of which depends on the duration of pregnancy and its death. In the mother, this situation often causes postpartum endometritis, bleeding, and infectious-toxic shock. After the water breaks, the baby’s lungs mature rapidly, therefore, in the absence of contraindications, if the rupture occurs before 34 weeks, doctors adhere to a wait-and-see approach and do not induce labor.

How to recognize the problem?

If there is no abundant outflow, it is quite difficult to determine leakage. This is due to hormonal changes in the second half of pregnancy. Discharge from the genital tract becomes profuse and thin, and some urine may be released spontaneously.

If the crack in the bladder shell is small or the rupture occurs from the side, the water flows out drop by drop and does not cause suspicion in the expectant mother. Meanwhile, this situation is the most dangerous: the fetus is not protected from infection, which means that every day without treatment may be its last.

Remember : if there are any changes in the nature of the discharge, immediately visit a doctor who will confirm or refute your worries.

Doctors determine water leakage using the following methods:

• Inspection with mirrors . Informative in case of excessive leakage.
• Examination of a smear under a microscope . Experts identify fetal skin scales, sebaceous gland cells, and hair in the woman’s secretions. The method takes time.
• Cytological test . Vaginal discharge, if it contains amniotic fluid, after applying to glass and drying, looks like fern leaves. However, the method gives an incorrect result in more than 20% of cases.
• Ultrasound. Informative in case of excessive leakage.
• One-time tests to detect traces of amniotic fluid in the vagina. Their action is based on determining the presence of certain substances.
• Determination of vaginal acidity (amniotest). Normally, the pH of the vagina is high, and the amniotic fluid is neutral or slightly alkaline. When there is leakage, the acidity of the vagina changes towards neutral, and the test changes color. However, with an inflammatory process in the vagina, the test may give an incorrect result. In addition, their reliability decreases over time.

If you notice a change in the amount and color of discharge, before visiting a doctor, try the following “diagnosis”:

• Place a clean diaper, folded several times, and evaluate the amount of discharge after an hour. Normally it will not be soaked through.
• Lie on your back or cough: this will release more water.
• Look at your stomach: if there is an outpouring, it sinks and decreases in circumference.

However, these methods are not effective enough. It is best to purchase one-time tests at the pharmacy in advance and carry them out at home if you suspect a leak.

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 ICI, they resort to installing a pessary, which 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.

Home therapy

Moderate oligohydramnios is treated without hospitalization if there is no obvious threat to the development of the fetus. The woman is observed on an outpatient basis, undergoing a course of appropriate therapy. First of all, medications are prescribed to eliminate the external cause of the flat bladder.

It is necessary to establish blood circulation in the placenta, and for this purpose drugs such as Kurantin and Autovegil are prescribed. Mineral and vitamin complexes for pregnant women will help support the body, increase resistance to disease, and improve metabolic processes.

Normal fetal development depends on the woman herself. In this situation, the expectant mother is advised to stay in bed, not exert herself physically, and completely give up bad habits. The transition to a balanced diet is important - healthy foods will not allow the body to fail. You should not limit yourself to fluids, observing the consumption rate established by your doctor.

It is forbidden to rely on folk recipes for a flat bladder; they will not help. It is allowed to use some of them in the treatment of external factors, as a concomitant of the main therapy, after agreement with the supervising physician. No self-medication.

A flat bladder is a rare phenomenon, observed in only 6% of pregnant women. To exclude an anomaly, a woman should undergo regular examinations. When a problem is noticed, it can be easily corrected in the early stages and then you will not have to resort to early opening of the amniotic sac.

Approximately 7-10% of women in the maternity hospital undergo an amniotomy. Pregnant women who hear about this manipulation for the first time are frightened by it. Natural questions arise: amniotomy, what is it? Is it dangerous for the child? Not knowing why this procedure is performed, many expectant mothers are negative in advance. Information about the indications, contraindications and possible consequences of amniotomy will help you understand whether your fears are justified.

Amniotomy is an obstetric operation (translated as amnion - water membrane, tomie - dissection), the essence of which is to open the amniotic sac. The amniotic sac and the amniotic fluid that fills it play an important role in the normal intrauterine development of the child. During pregnancy, they protect the fetus from external mechanical influences and microbes.

After opening or natural rupture of the amnion, the uterus receives a signal to expel the fetus. As a result, contractions begin and the baby is born.

The manipulation of opening the amniotic sac is carried out with a special tool in the form of a hook at the moment when the bubble is most pronounced, so as not to damage the soft tissues of the baby’s head. Amniotomy is a completely painless operation, since there are no nerve endings on the membranes.

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.”

How does a woman feel during an amniotomy?

Bladder puncture before childbirth - painful or not? Any woman is afraid of such a procedure because of the possible pain. However, in this case, no unpleasant sensations are observed, because the amniotic sac has no nerve endings.

A woman just needs to relax and take a comfortable position. All she can feel after a correctly performed procedure is only the leakage of amniotic fluid.

When muscles are tense, discomfort and negative consequences may occur in the form of injury to the vaginal walls.

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 a woman feels the onset of contractions, 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.

Why and when is the puncture procedure done?

There are cases when the membranes covering the fetus do not burst on their own during childbirth, or there is a risk of severe complications in the later stages, and labor has to be artificially induced. Then an amniotomy is performed - a puncture of the fetal bladder, that is, rupture of its membranes with a special instrument.

The procedure is carried out only according to indications:

1. stimulation of labor in postterm pregnancy, more than 41 weeks, Rh conflict, gestosis of the pregnant woman;
2. weak labor activity;
3. protracted labor lasting several days;
4. flat amniotic sac;
5. membranes that are too dense and do not rupture on their own during childbirth;
6. placenta previa.

It is most convenient to carry out the procedure on a gynecological chair during the examination.

Only after assessing the degree of dilatation of the uterine pharynx and the woman’s readiness for childbirth, as well as having received the consent of the woman in labor, does the doctor have the right to proceed with amniotomy. Following all the rules of antiseptics, the obstetrician-gynecologist inserts the jaw of the bullet forceps into the cervical canal and punctures the membranes. During the procedure, the doctor uses his fingers to help the anterior waters recede. Amniotomy lasts up to 5 minutes. The woman only feels the leakage of amniotic fluid.

Depending on the period of the procedure, the puncture can be:

• timely - when the cervix is ​​dilated by 7 cm and is ready for childbirth;
• early - when labor has already begun, but the uterine os has not yet fully opened;
• belated - the cervical canal has fully opened, labor progresses, but rupture of the membranes is not observed;
• premature - even before labor begins. When there is a risk of complications, and there is no labor activity, the amniotic sac is punctured without contractions.

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.

The concept of isthmic-cervical insufficiency

So, we found out that ICI is a pathological condition of the uterine isthmus or the cervix itself that occurs during pregnancy. The consequences may be as follows:

• Exit of part of the amniotic sac into the cervical canal.
• Development of prolapse of the membranes into the vaginal area.
• Prolapse of the membranes.

If the cervical canal dilates and the wall of the fetal bladder bulges into the cervix or vagina, the pregnant woman requires immediate hospitalization. It often happens that hospital stay is required until the birth, since the main task of doctors is to maintain the pregnancy.

According to the survey, during the development of pathology, the mother rarely feels the pathological process itself. More often, she already feels the very consequences of prolapse. Despite this, there are still several symptoms that indicate the development of this negative condition.

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