Arom And Rcr: When To Combine For Best Results

Arom, or artificial rupture of membranes, is a technique used to induce or augment labour by breaking the amniotic sac. It is performed by a physician or advanced practice registered nurse and can be done using a plastic membrane perforator or a hook. The procedure carries risks such as umbilical cord prolapse, bleeding, and infection, so it is important to ensure the cervix is ready for labour induction and the fetal vertex is in a position that minimises the chance of umbilical cord prolapse.

AROM to induce labour

AROM stands for Artificial Rupture of Membranes, also known as an amniotomy or "breaking the water". It is the intentional rupture of the amniotic sac by an obstetrical provider.

AROM is performed when there is a need to induce labour or augment uterine activity. It is also performed to enable the doctor or midwife to monitor the baby's heartbeat internally, to check the colour of the amniotic fluid, and to avoid the baby aspirating the contents of the amniotic sac during birth.

AROM is performed by a midwife or obstetrician. The membranes can be ruptured using a specialised tool, such as an amnihook or amnicot, or they may be ruptured by the proceduralist's finger.

With the amnihook method, a sterile plastic hook is inserted into the vagina and used to puncture the membranes containing the amniotic fluid. With the membranes punctured, amniotic fluid is able to escape from the uterus and exit the vagina.

Benefits and Risks of AROM:

Benefits:

• Some evidence shows that breaking the waters may result in shorter labour.
• Breaking the waters may cause contractions to become stronger and more regular.
• Breaking the waters allows your provider to assess the colour and odour of your amniotic fluid; this will let them know if your baby has passed meconium in utero.
• If you need to monitor the baby more closely and external monitors won't work, amniotomy will let you place an internal monitor.

Risks:

• Experiencing a quick increase in the intensity of contractions (which could be good or bad).
• Losing the "cushion" from the amniotic fluid can possibly cause the umbilical cord to become compressed. Umbilical cord compression can lead to heart rate fluctuations and low oxygen levels.
• If your baby is not already in the optimal position for birth, losing that fluid may make it difficult for the baby to rotate into a better position.
• Because the amniotic sac provides protection to the baby, there is an increased risk of infection the longer the amniotic sac is ruptured.
• There is a chance that, along with the flow of amniotic fluid, the umbilical cord could prolapse from the vagina; this is a medical emergency requiring an emergency caesarean section.
• While rare, there is a condition called "vasa previa" where blood vessels run along the amniotic sac. If there is an undiagnosed vasa previa, there is a chance one of these vessels could be nicked, resulting in severe blood loss to the baby (haemorrhage).

AROM to augment labour

Amniotomy, or artificial rupture of membranes (AROM), is a procedure in which a practitioner manually breaks the water by puncturing the amniotic sac to speed up labour. The procedure is typically carried out by a midwife or obstetrician using a specialised tool, such as an amnihook or amnicot, or their finger.

AROM is used to augment labour by stimulating the uterus to increase the frequency, duration, and intensity of contractions. It is also used to induce labour, though evidence suggests that it is ineffective in shortening the length of the first stage of labour and may increase the likelihood of a caesarean section.

There are several indications for performing AROM:

• To augment a stalled labour or induce labour: Relieving the amniotic sac of fluid is believed to induce uterine contraction activity, increase the strength of contractions, and augment labour. However, the effectiveness of AROM for these purposes is debated, with conflicting data from various studies.
• Internal monitoring of the baby: AROM allows for the placement of internal fetal monitoring devices, such as a scalp electrode, to directly assess the baby's heartbeat and provide a more reliable indication of fetal well-being.
• Check the colour of the amniotic fluid: If meconium (the contents of the baby's bowel) is suspected to be present, additional preparations, such as suctioning, and increased personnel are required.
• Prevent the baby from aspirating the amniotic fluid: In rare cases, the baby may be born with an intact amniotic sac, which must be quickly broken to allow the baby to breathe.

Certain criteria must be met for AROM to be performed:

• The mother should have no contraindications for vaginal delivery.
• The mother should be in labour or have an indication for delivery.
• The fetal head should be engaged (0 station or more).

While AROM can be beneficial, it also carries risks, including umbilical cord prolapse, infection, and bleeding. Therefore, it should only be performed when there is a clear medical indication, and the expected benefits outweigh the potential harms.

Risks of AROM

The artificial rupture of membranes (AROM) is a common procedure that has been performed for hundreds of years. It involves rupturing the amniotic sac to induce labour contractions. While AROM is intended to speed up labour, there are several risks associated with the procedure.

Firstly, AROM may result in umbilical cord prolapse, where the umbilical cord slips past the baby's head into the vagina, cutting off the baby's circulation and requiring an emergency C-section. This is considered the most common complication of AROM. Secondly, there is a risk of umbilical cord compression, where the umbilical cord is flattened and restricts the baby's oxygen supply. Thirdly, AROM can lead to an increased risk of infection for the baby, as the amniotic fluid provides a protective barrier against infections. The risk of infection increases the longer the time between the water breaking and delivery. Fourthly, AROM may cause increased pain and more intense contractions for the mother, as the cushioning effect of the amniotic fluid is lost. Finally, there is a risk of placental abruption, bleeding, and injury to the fetus or surrounding tissues.

It is important to note that the effectiveness of AROM is debated among healthcare providers and medical researchers. While some studies suggest that it can speed up labour, others indicate that it does not significantly shorten the length of labour and may even increase the likelihood of a C-section. Therefore, it is recommended to carefully weigh the risks and benefits before proceeding with AROM.

Benefits of AROM

The benefits of AROM (artificial rupture of membranes) are currently debated, with some sources claiming that it does not shorten the length of the first stage of labour, and may increase the likelihood of a caesarean section. However, other sources claim that AROM can shorten labour by about 5 hours, and that it is particularly effective when combined with intravenous oxytocin.

Advocates for AROM argue that it can augment uterine contractions, preventing or treating a delay in the first stage of labour. It also allows for an inspection of the amniotic fluid, which is especially important in high-risk cases or if the foetal heart rate pattern is abnormal.

AROM is also used to treat blood clots in the lower extremities, and can be used to prevent complications in the cardiovascular system.

Who can perform an AROM

In the context of childbirth, AROM stands for Artificial Rupture of Membranes, also known as amniotomy or "breaking your water". This procedure is used to break a pregnant woman's amniotic sac, which is a pouch of fluid that surrounds and protects the baby. The breaking of the amniotic sac releases hormones that signal the body to begin or intensify labour contractions.

AROM can be performed by a range of healthcare providers, depending on the setting and the woman's preferences. Here are the types of healthcare providers who can perform AROM:

• Family practitioners: Family practitioners, also known as family medicine doctors, provide comprehensive healthcare to adults and children, including labour and delivery care.
• Midwives: Midwives are healthcare professionals who provide prenatal, labour, and delivery care, as well as some gynecologic care. Certified nurse-midwives (CNM) and certified professional midwives (CPM) may be able to perform AROM during home births in certain states.
• Obstetricians/gynaecologists (OB/GYNs): These specialists have expertise in women's health, pregnancy, and labour and delivery. They are qualified to perform AROM in hospital or birthing centre settings.

It is important to discuss all treatment options with your doctor or healthcare provider to understand the risks, benefits, and alternatives associated with AROM.

Frequently asked questions