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Consult the state’s nurse practice act and the organization’s practice to determine which level of clinician may perform an artificial rupture of membranes (AROM).
Ensure that a practitioner is immediately available in the event an emergency related to the procedure occurs.
An AROM, or amniotomy, may be performed by a physician or an advanced practice registered nurse (APRN) for the purpose of shortening labor by stimulating the uterine contraction pattern. An AROM may be performed using a sterile, disposable plastic membrane perforator (Figure 1).undefined#ref4">4
An AROM should be performed only after the practitioner determines that the cervix is favorable for labor induction and when the fetal vertex is at a station that minimizes the opportunity for umbilical cord prolapse.4 Once the amniotic sac is ruptured, the amniotic fluid is allowed to drain slowly. If the fetal presenting part is well applied to the cervix, a small amount of fluid should be seen upon membrane release. An AROM may be performed alone or in combination with the administration of pharmacologic agents.
The nurse may provide the practitioner with sterile supplies, monitor the maternal and fetal responses to the AROM, and document the procedure and characteristics of the amniotic fluid. Abnormal characteristics of amniotic fluid include blood, meconium staining or meconium particulates, and signs of infection (chorioamnionitis) (e.g., foul odor, purulence). Amniotic fluid is normally clear with a mild musty odor. Small pieces of vernix may be observed; larger amounts of vernix in the fluid may suggest fetal prematurity. Green or muddy yellow meconium-stained fluid may indicate interruption of oxygenation to the fetus. Meconium-stained amniotic fluid may indicate the need for resuscitative measures for the newborn after delivery, such as positive pressure ventilation. Routine intubation for tracheal suction of newborns delivered through meconium-stained fluid is not recommended.5 Meconium may also be present if the fetus is in a breech position and the fetal abdomen is compressed.
Once the amniotic membranes rupture, a risk of intrauterine infection exists, and the risk increases with the duration of the membrane rupture.1 Antibiotics should be administered to a patient with intrapartum risk factors, such as when a rupture occurred more than 18 hours ago and Group Beta Streptococcus (GBS) culture results are unknown or indications of infection such as chorioamnionitis or pyelonephritis are noted.2 Contraindications to an AROM include active vaginal infections (e.g., genital herpes)3 because the recommended route of birth in a patient with that condition is cesarean delivery.
Risks resulting from an AROM include umbilical cord prolapse, umbilical cord compression, bleeding from an undiagnosed vasa previa, intra-amniotic infection, and placental abruption.4
Rationale: The fluid that drains after an AROM may soak the patient’s linens if adequate preparation is not made to absorb it.
Maintain aseptic technique throughout the procedure to avoid introducing pathogens into the uterus.
Rationale: FHR changes may indicate umbilical cord prolapse or cord compression.
Normal accelerations in FHR may occur during and after an AROM because of fetal scalp stimulation.
Rationale: Monitoring the amniotic fluid for signs of infection, blood, or meconium is critical when preparing for appropriate interventions at delivery.
Jozwiak, M. and others. (2012). Mechanical methods for induction of labour. Cochrane Database of Systematic Reviews, 3, Art. No.: CD001233. doi:10.1002/14651858.CD001233.pub2 (classic reference)*
Simpson, K.R. (2013). Cervical ripening and labor induction and augmentation: Practice monograph (4th ed.). Washington, DC: Association of Women’s Health, Obstetric and Neonatal Nurses.
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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