Aromatherapy: Strict Contraindications You Need To Know

Aromatherapy is a holistic healing practice that uses essential oils to promote physical and emotional well-being. While it offers numerous benefits, it's crucial to understand the potential risks associated with its use. Contraindications refer to medical reasons for not using certain treatments, and in aromatherapy, they can be divided into two types: absolute and relative. Absolute contraindications mean there are no reasonable circumstances to pursue a treatment, while relative contraindications indicate that a treatment is inadvisable but not entirely ruled out.

Identifying these contraindications is vital to ensure the safety of individuals undergoing aromatherapy. For instance, certain medical conditions, such as asthma or epilepsy, may increase susceptibility to negative reactions or interactions with specific essential oils. Additionally, pregnant women need to exercise caution as some oils may pose risks to the developing fetus. It is always recommended to consult with a qualified aromatherapist or healthcare professional to determine the appropriate use of essential oils for specific circumstances.

Malpresentation, vasa previa, velamentous insertion of the umbilical cord, or an unengaged fetal head/unstable lie

Malpresentation, vasa previa, velamentous insertion of the umbilical cord, and an unengaged fetal head/unstable lie are all conditions that can complicate pregnancy and labour. In such cases, an Artificial Rupture of Membranes (AROM) or amniotomy may be contraindicated.

Malpresentation

Malpresentation refers to an abnormal position of the fetus in the uterus, which can make vaginal delivery difficult or dangerous. The most common type of malpresentation is a breech presentation, where the baby's bottom or feet emerge first instead of the head. Other types of malpresentation include transverse lie, where the baby lies horizontally across the uterus, and oblique lie, where the baby is positioned diagonally. In cases of malpresentation, especially complete breech presentation, a Caesarean section may be recommended to reduce the risk of complications during delivery.

Vasa Previa

Vasa previa is a rare but serious pregnancy complication where the fetal blood vessels from the umbilical cord run through the membranes close to or over the cervical opening. This condition poses a significant risk of severe blood loss and even death for the fetus if not carefully managed. The success rate of diagnosed vasa previa pregnancies is 97-98.6%. The condition is typically detected during routine pregnancy ultrasounds and can be effectively managed through early diagnosis, careful monitoring, and scheduled Caesarean section deliveries.

Velamentous Insertion of the Umbilical Cord

Velamentous insertion of the umbilical cord is a type of vasa previa where the umbilical cord blood vessels travel outside the placenta, leaving them unprotected and vulnerable to rupture. This condition can occur in conjunction with vasa previa, further increasing the risk of fetal blood loss during labour.

Unengaged Fetal Head/Unstable Lie

An unengaged fetal head or unstable lie refers to when the baby's head has not yet entered the birth canal or is not firmly positioned in the pelvis. This can be a concern during labour as it may indicate that the baby is not in the optimal position for vaginal delivery. In such cases, careful monitoring is required, and interventions such as controlled amniotomy or the application of fundal or suprapubic pressure may be considered to facilitate delivery.

In summary, these conditions present unique challenges during pregnancy and labour, and healthcare providers must carefully assess each situation to determine the best course of action, which may include alternative delivery methods or additional monitoring and interventions to ensure the safety of both the mother and fetus.

Active vaginal infections, such as genital herpes

Genital herpes is a common sexually transmitted infection (STI) caused by two types of viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). It is estimated that in 2018, there were 572,000 new genital herpes infections in the US among people aged 14 to 49. Genital herpes is characterised by blisters and open sores (lesions) in the genital area, but it can also be asymptomatic, meaning a person does not show any symptoms. The sores usually appear as one or more blisters on or around the genitals, rectum, or mouth, and this is known as having an "outbreak". The blisters break and leave painful sores that may take a week or more to heal.

If a patient has an active vaginal infection, such as genital herpes, at the time of delivery, a cesarean section (C-section) is recommended to reduce the risk of transmitting the infection to the newborn. This is because, during an AROM, there is a risk of intrauterine infection, which increases with the duration of the membrane rupture. Therefore, it is essential to consider the presence of active vaginal infections, such as genital herpes, when determining the appropriate route of delivery and whether to perform an AROM procedure.

To reduce the risk of transmitting genital herpes to a sexual partner, it is recommended to use condoms consistently and correctly. Additionally, informing the partner about the infection and avoiding sexual activity during an outbreak are crucial. For pregnant individuals with genital herpes, prenatal care visits are vital, as the infection may lead to miscarriage or preterm delivery. Treatment with anti-herpes medication towards the end of pregnancy can help reduce the risk of having an active outbreak during delivery.

The patient refuses the intervention

When a patient refuses a medical intervention, it is important to respect their autonomy and decision-making capacity. In the case of a patient refusing an AROM (artificial rupture of membranes), there are several steps that healthcare providers can take to ensure the patient's rights are respected while also providing necessary care.

Firstly, it is crucial to understand the reasons behind the patient's refusal. Healthcare providers should engage in open and non-judgmental communication with the patient to explore their concerns, values, and beliefs. By understanding the patient's perspective, providers can better address their refusal and find alternative solutions.

Secondly, providers should ensure that the patient has all the necessary information to make an informed decision. This includes explaining the benefits, risks, and alternatives to the procedure, as well as answering any questions or addressing any misconceptions the patient may have. It is important that the patient feels supported and educated in their decision-making process.

Additionally, providers should assess the patient's capacity to make informed decisions. This includes evaluating their mental capacity, understanding of the information presented, and freedom from coercion or undue influence. If the patient lacks decision-making capacity, their refusal may not be valid, and further steps may need to be taken, such as involving a legal guardian or seeking additional medical opinions.

In the context of AROM, it is important to note that this procedure is often performed to induce or expedite labour, facilitate internal monitoring of the baby's heartbeat, check the colour of the amniotic fluid, or prevent the baby from aspirating the amniotic sac during birth. If a patient refuses this intervention, alternative methods may be considered, such as oxytocin infusion for labour induction or external fetal monitoring. However, it is crucial to respect the patient's autonomy and not coerce them into accepting the procedure if they have valid concerns or reasons for refusal.

Ultimately, when a patient refuses an intervention like AROM, healthcare providers should prioritize patient-centred care, informed consent, and shared decision-making. By respecting the patient's refusal, providing education, and exploring alternative options, providers can ensure that the patient's rights and well-being are at the forefront of their care.

The patient is not in active labour

One of the strict contraindications to AROM is when the patient is not in active labour. This is because the procedure is used to induce or expedite labour, or to place internal monitors. If the patient is not in labour, there is no reason to perform the procedure.

AROM, or amniotomy, is the procedure by which the amniotic sac is deliberately ruptured to release amniotic fluid. This can be done to induce labour, to speed up labour, or to place internal monitors on the baby. The procedure is typically performed by a physician, APRN, midwife, or obstetrician.

There are several reasons why AROM may be performed. Firstly, it can be used to induce labour, usually in conjunction with an oxytocin infusion. It can also be used to speed up labour, as the release of amniotic fluid stimulates uterine contractions and increases plasma prostaglandins. Additionally, AROM can be used to monitor the baby's heartbeat internally, providing a more reliable indication of the baby's wellbeing. This is often done if there are complications or if the mother is being induced.

Another reason for performing AROM is to check the colour of the fluid. If meconium is suspected to be present, suctioning must be set up and additional personnel are required. Finally, AROM may be performed to avoid the baby aspirating the contents of the amniotic sac during birth.

There are several contraindications to AROM, including when the patient is not in active labour. Other contraindications include malpresentation, vasa previa, suspected velamentous insertion of the umbilical cord, an unengaged fetal head, or an unstable lie. Additionally, if the patient refuses the intervention, AROM should not be performed.

There is an increased risk of umbilical cord prolapse

Umbilical cord prolapse is a rare but serious complication that can occur during pregnancy and delivery. It is when the umbilical cord exits the cervical os before the presenting part of the fetus. This can result in compression of the cord, leading to vasoconstriction and fetal hypoxia, which can be fatal or cause permanent disability if not promptly addressed. The risk of umbilical cord prolapse is increased by certain features of pregnancy that prevent the proper engagement of the presenting part with the pelvis. These include fetal malpresentation, multiple gestations, polyhydramnios, preterm rupture of membranes, intrauterine growth restriction, preterm delivery, and fetal and cord abnormalities.

One of the key iatrogenic risk factors for umbilical cord prolapse is amniotomy or artificial rupture of membranes (AROM) without an engaged fetal presenting part. AROM is a procedure performed to induce or expedite labour or to facilitate the placement of internal monitors. When performed without ensuring the proper engagement of the fetal presenting part, AROM can increase the risk of umbilical cord prolapse.

To mitigate the risk of umbilical cord prolapse during AROM, it is crucial to confirm the engagement of the fetal head before rupturing the amniotic sac. Additionally, in cases with a high risk of cord prolapse, such as polyhydramnios or high fetal station, using a needle instead of a hook to rupture the amniotic sac can help slow the flow of amniotic fluid. While the efficacy of this technique is yet to be fully established, it may provide a margin of safety in high-risk situations.

Furthermore, it is essential to closely monitor the patient's condition during and after AROM. Any signs of fetal bradycardia or recurrent variable decelerations, especially following membrane rupture, should prompt an immediate evaluation for potential cord prolapse. Early recognition and intervention are critical to reducing adverse outcomes.

In summary, while AROM is a commonly performed procedure, it is essential to be aware of the potential risk of umbilical cord prolapse, especially when the fetal presenting part is not fully engaged. Proper assessment, careful technique, and vigilant monitoring are key to mitigating this risk and ensuring favourable outcomes for both mother and fetus.

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