Artificial Rupture of Membranes and Fetal Scalp Electrode

Artificial Rupture of Membranes and Fetal Scalp Electrode Kathryn Jacobe MD University of Wisconsin Fox Valley FMR

AROM : Basics � Membranes are ruptured during a vaginal exam › With a crochet-like long hook › With a “finger-cot” � Head needs to be well engaged › Prevents cord prolapse � Typically rupture during a contraction › Again, to prevent cord prolapse

AROM : indications � Need to further evaluate fetal status with a fetal scalp electrode � Need to monitor uterine contractions with an IUPC � Controversy over whether it is effective as a 1 st step in labor augmentation � AROM DOES allow you to assess the fluid for blood or meconium which might allow you to prepare for labor differently.

AROM: controversy � October › › 5, 2011 cochrane review: 15 studies, 5583 women No shortening of 1 st stage of labor Possible increase in cesarean rate Thus, per cochrane, routine amniotomy not recommended for labors progressing normally, OR for labors which have become prolonged.

AROM : contraindications � � active hepatitis B, Active hepatitis C, Active HIV infection Active Herpes (may consider c-section anyway) (in order to minimize exposure of the fetus to ascending infection) � Anything that would contraindicate vaginal delivery › Non-vertex position › Placenta previa or vasa previa � Inadequate dilation to allow rupture (need to be AT LEAST 1 and 1 is hard… 2 to 3 is better) � Positive GBS carrier status is not a contraindication to amniotomy

AROM : complications � Cord prolapse � Prolonged rupture of membranes (if pt has labor distocia) leading to increased risk of infection � Scratching the baby! Yikes…

Fetal Scalp Electrode : Basics � � � Confirm presenting part is the vertex and ensure adequate cervical dilation with sterile vag exam. Amniotomy if membranes are still intact Aseptically handle the scalp electrode and introducer Free the tail wire to allow free rotation of the electrode in the introducer Place tip of applicator tube between pads of index and long fingers of hand used for vag exam, keep electrode spiral down inside introducer Do the vag exam, wait for the next contraction › › Make sure not to place the electrode on either fontanelle OR on the face Apply over skull plates only Turn outer handle of electrode clockwise until tip stops turning (usually 2 turns) Gently retract handle while leaving exam hand in place to make sure tip does not pull free. � Palpate around electrode to ensure it isn’t applied to the maternal cervix � Release wire ends and remove applicator � Await connection and good tracing � �

Fetal Scalp Electrode : Basics

FSE : indications � Poor quality external fetal heart-rate tracing � Sometimes used for births that are expected to be complicated to allow close monitoring of FHR during 2 nd stage (when its hardest to use external monitors) � Cervix needs to be dilated to 2 -3 cm to allow

FSE : contraindications � Anything that would prevent amniotomy (active hepatitis B, Active hepatitis C, Active HIV infection , Active Herpes) � Known or suspected fetal coagulation disorder � Presentation other than vertex

FSE : complications � Potential for fetal scalp abscess � Cephalohematoma � CSF leak � CSF seeding with GBS and increased mortality rate if untreated for early neonatal GBS sepsis � Trauma to structures other than the scalp if mis-placed

resources � Up to date � Internet google search images � Pfennninger and Fowler. Procedures for primary care 2 nd edition.