Specific features of labor management in case of late discharge of amniotic fluid
Jun 13, 2018
There are 3 variants of for untimely discharge of amniotic fluid :
• premature discharge - opening of the bladder before the onset of labor( until regular bouts and before the onset of structural changes in the cervix in the form of its shortening, smoothing and unfolding);
• Early discharge - opening the fetal bladder after the onset of regular contractions, but before the full or almost complete opening of the cervix;
• belated outflow - opening of the bladder after some time after the onset of complete opening of the cervix.
Premature and early outpouring of amniotic fluid are considered as complications in which infection from the vagina can enter the uterine cavity. Such an ascent of the infection occurs only 6 hours after the rupture of the fetal bladder. As a result, not only metroendometritis develops, but the fetus also becomes infected, which can lead to the development of a number of complications in it, primarily to the development of intrauterine pneumonia, hypoxia, and in especially severe cases, to death before or soon afterbirth. In obstetric practice, much attention is paid to the evaluation of the so-called anhydrous interval, i.e., the period from the moment of the outflow of amniotic fluid before birth. If the anhydrous interval lasts more than 6 hours, the woman should be prescribed antibacterial therapy to prevent infection of the uterine cavity. Antibiotics of a wide spectrum of action, not having a negative influence on the fetus, are prescribed. These include semi-synthetic penicillins( ampicillin, oxacillin, methicillin), which are prescribed as intramuscular injections or inside tablets of 25-500 mg four times a day.
The most frequent complications of the birth process include:
• untimely outflow of amniotic fluid;
• overgrowth of the uterus with a very large fetus;
• premature delivery;
• placenta previa;
• premature detachment of a normally located placenta.
In order to prevent ascending infection of the birth canals, untimely outflow of amniotic fluid should refrain from frequent( unreasonable) vaginal examinations. To prevent the development of infection in childbirth, the vaginal sanitation is performed in women suffering from colpitis. For this, various disinfectant and antibacterial agents are applied locally: solutions of furacilin, rivanol, iodinol, sintomycin emulsion, etc. The necessary sanation should be carried out long before the expected term of labor in the antenatal clinic or in the antenatal department.
If premature rupture of amniotic fluid occurs with sufficiently pronounced signs of "maturity" of the cervix, then it is necessary to continue monitoring the woman for 2-3 hours. In parallel, estrogen is prescribed to create a hormonal "background" in the event of possible future use of parental therapy, measures are takenon the prevention of fetal hypoxia. In most cases, in this situation for 2-3 hours, the activity begins and develops spontaneously.
If a premature outpouring of amniotic fluid occurs when the cervix is "immature", then antispasmodic drugs and an enzyme called lidazum are prescribed simultaneously with hormones. Premature discharge of water in the "unripe" state of the cervix in conjunction with other weight factors( primordial elderly, pelvic presentation of the fetus, the presence of a large fetus, late toxicosis of pregnant women, etc.) may be an indication for the operative delivery of a woman.
In connection with the development of weakness in labor activity in the early discharge of amniotic fluid, rhodostimulating therapy is often used. In parallel, it is necessary to take measures to prevent and treat intrauterine fetal hypoxia, and also to prescribe antispasmodics. After a premature or early discharge of amniotic fluid, complications in the postpartum and early post-partum periods may occur as bleeding due to a decrease in the tone and excitability of the uterus, as well as an anomaly in the attachment of the placenta to the uterine wall.