Artificial Rupture of Membrane during labor.pptx

This is an educational PPT about ARM, its methods and articles required.

1. Artificial Rupture of Membranes Aleena Mary Varghese

2. Introduction Induction of labor (IOL) means initiation of uterine contractions (after the period of viability) by any method (medical, surgical or combined) for the purpose of vaginal delivery. Augmentation of labor is the process of stimulation of uterine contractions (both in frequency and intensity) that are already present but found to be inadequate.

3. Surgical Induction Methods Artificial rupture of the membranes (ARM) Stripping the membranes

4. Artificial Rupture of the Membranes (ARM ) Advantages: High success rate Chance to observe the amniotic fluid for blood or meconium Access to use fetal scalp electrode or intrauterine pressure catheter or for fetal scalp blood sampling Limitation: It cannot be employed in an unfavorable cervix (long, firm cervix with os closed). The cervix should be at least one finger dilated

5. Artificial Rupture of the Membranes (ARM ) Indications Abruptio placentae Chronic hydramnios Severe pre-eclampsia/ eclampsia In combination with medical induction To place scalp electrode for electronic fetal monitoring

6. Artificial Rupture of the Membranes (ARM ) Contraindications: Maternal AIDS Genital active herpes infection. Immediate beneficial effects of ARM Lowering of the blood pressure in pre-eclampsia-eclampsia Relief of maternal distress in hydramnios Control of bleeding in APH Relief of tension in abruptio placentae and initiation of labor.

7. Artificial Rupture of the Membranes (ARM ) HAZARDS OF ARM Once the procedure is adopted, there is no scope of retreating from the decision of delivery Chance of umbilical cord prolapse: The risk is low with engaged head or rupture of membranes with head fixed to the brim Amnionitis : Careful selection of cases with favorable pre-induction score will shorten the induction-delivery interval. Meticulous asepsis during the procedure reduces the risk . Accidental injury to the placenta, cervix or uterus, fetal parts Liquor amnii embolism (rare ) Uncontrolled escape of amniotic fluid and placental abruption

8. Artificial Rupture of the Membranes (ARM ) Procedures: Preliminaries : The patient is asked to empty her bladder Actual steps FHR status is monitored before and after the procedure The patient is in lithotomy position Full surgical asepsis is to be taken Two fingers are introduced into the vagina smeared with antiseptic ointment The index finger is passed through the cervical canal beyond the internal os

9. Artificial Rupture of the Membranes (ARM ) The membranes are swept free from the lower segment as far as reached by the finger With one or two fingers still in the cervical canal with the palmar surface upwards, a long Kocher’s forceps with the blades closed or an amnion hook is introduced along the palmar aspect of the fingers up to the membranes. The blades are opened to seize the membranes and are torn by twisting movements. Amnihook is used to scratch over the membranes. This is followed by visible escape of amniotic fluid .

10. Artificial Rupture of the Membranes (ARM ) Kocher’s Artery Forceps Tip of Kocher’s Artery Forceps

11. Artificial Rupture of the Membranes (ARM ) ARM using Kocher’s Artery Forceps

12. Artificial Rupture of the Membranes (ARM ) AMNIHOOK

13. Artificial Rupture of the Membranes (ARM ) ARM using AMNIHOOK

14. Artificial Rupture of the Membranes (ARM ) After the membranes rupture, the following are to be assessed : Color of the amniotic fluid Status of the cervix Station of the head Detection of cord prolapse if any FHR pattern is again checked A sterile vulval pad is placed Prophylactic antibiotic may be prescribe

15. Questions?