Performing Aromatherapy: Enhancing Patient Experience And Wellbeing

Active Range of Motion (AROM) is a type of exercise performed by a patient without any assistance. The patient uses their own muscles to move a joint through its full range of motion. AROM is often used in physical therapy to improve the range of motion of a joint that has been injured or restricted. It can help increase flexibility, strengthen muscles, improve function, and reduce pain. Similarly, in the context of obstetrics, AROM or amniotomy is the procedure by which the amniotic sac is deliberately ruptured to cause the release of amniotic fluid. This is usually done to induce or expedite labor or to facilitate the placement of internal monitors.

To induce labour

Amniotomy, or artificial rupture of membranes (AROM), is a procedure in which a healthcare provider manually breaks the amniotic sac to induce or expedite labour. This is done by puncturing the amniotic sac with a hook, which causes a release of amniotic fluid.

AROM is often performed to induce labour, usually in conjunction with an oxytocin infusion. The procedure is based on the idea that breaking the amniotic sac will induce the body to produce hormones, such as oxytocin, that help kick-start contractions.

The effectiveness of AROM in inducing labour is debated. While some studies show that it is an effective method of induction, others suggest that it does not significantly shorten the length of labour or improve outcomes. The American College of Obstetricians and Gynecologists (ACOG) recommends that labour and delivery teams wait longer to perform this procedure in low-risk pregnancies where mother and baby are progressing normally.

AROM carries several risks, including a prolapsed cord, increased risk of infection, and difficulty in monitoring the baby's heart rate. Additionally, losing the amniotic fluid cushion can cause the umbilical cord to become compressed, leading to heart rate fluctuations and low oxygen levels for the baby.

To augment labour

Amniotomy, or artificial rupture of membranes (AROM), is a procedure used to augment labour by rupturing the amniotic sac and releasing amniotic fluid. This can be done to induce or speed up labour, as it is believed that the rupturing of the amniotic sac induces uterine contraction activity, increases the strength of contractions, and may augment labour.

AROM is typically performed at the bedside in the labour and delivery suite. The patient is placed in the lithotomy position, and the provider will use an amnihook (a long plastic device that resembles a large crochet needle) to puncture the amniotic sac.

The effectiveness of AROM in augmenting labour is debated. While some studies have shown that AROM can shorten labour, others suggest that it does not accomplish this outcome. A meta-analysis of AROM to shorten spontaneous labour found no discernible difference compared to no amniotomy. However, when there is a delay in labour, AROM in conjunction with oxytocin may modestly reduce the rate of caesarean section.

AROM carries several benefits and risks. Some benefits include a shorter labour, stronger and more regular contractions, and the ability to assess the colour and odour of amniotic fluid. On the other hand, risks include a quick increase in contraction intensity, possible umbilical cord compression, difficulty for the baby to rotate into a better position, increased risk of infection, and umbilical cord prolapse.

The decision to perform AROM should be made in consultation with the patient, taking into account their preferences and the potential benefits and risks of the procedure.

To allow for internal fetal monitoring

Internal fetal monitoring is a procedure in which a wire electrode is placed on the part of the fetus closest to the cervix, usually the scalp, to record the heart rate. Uterine contractions may also be monitored with a special tube called an intrauterine pressure catheter that is inserted through the vagina into the uterus. This method of monitoring can be used only after the membranes of the amniotic sac have ruptured.

Internal fetal monitoring is recommended when external monitoring is suboptimal due to factors such as the position of the fetus and/or maternal habitus. It is also considered more accurate than external monitoring as it can monitor the actual strength or pressure of contractions, expressed in Montevideo units, whereas external monitoring can only detect their frequency and duration.

However, internal fetal monitoring requires cervical dilation and amniotomy, which can increase the risk of intrauterine infection, fetal injury, and the transmission of viruses such as herpes simplex and hepatitis B or C. It also requires the patient to be tethered with cords to a monitoring machine and can cause a small cut, mark, or abscess on the baby's scalp.

To assess the quality of amniotic fluid

One of the main reasons for performing an AROM is to assess the quality of the amniotic fluid. The amniotic fluid should be clear and odorless, but in some cases, it may contain meconium or be blood-tinged. The colour of the fluid can indicate potential issues with the pregnancy. For example, if the fluid is brown or green, it means that the baby has passed meconium in utero, which could be a sign of fetal distress. Light bleeding or pink-tinged amniotic fluid is considered normal, but if the fluid is predominantly blood, it could indicate a problem. Examining the amniotic fluid allows healthcare providers to identify any potential issues and make informed decisions about the patient's care.

The amniotic fluid provides important information about the health of the pregnancy and the baby. It acts as a cushion to protect the baby from injury and also helps regulate the baby's temperature. The baby also practices swallowing in the womb by swallowing the amniotic fluid. Additionally, amniotic fluid has antimicrobial properties, which help protect the baby from infection during pregnancy.

Performing an AROM allows healthcare providers to visually inspect the amniotic fluid and evaluate its colour, odour, and consistency. This assessment helps identify any potential issues or complications that may impact the labour and delivery process. By analysing the amniotic fluid, healthcare providers can make more informed decisions about the patient's care and take appropriate actions to ensure the best possible outcome for both the mother and the baby.

The procedure for performing an AROM involves the use of a specially designed hook or finger cot to puncture the amniotic membrane and release the amniotic fluid. This process is typically done at the bedside in the labour and delivery suite. After the AROM, healthcare providers will closely monitor the patient and the baby, paying attention to vital signs, fetal heart rate, and any changes in the amniotic fluid.

To allow for direct pressure from the fetal scalp on the uterine cervix

The rupture of the amniotic sac causes the release of amniotic fluid, which stimulates uterine contractions. This can help induce or expedite labour, or be done in anticipation of the placement of internal monitors. The procedure is typically carried out using a sterile plastic hook (known as an amnihook) or a finger cot with a hook on the end.

Practitioners believe that amniotomy can help induce labour or augment spontaneous labour. It is thought that relieving the amniotic sac of amniotic fluid induces uterine contraction activity, increases the strength of contractions, and may augment labour by allowing direct pressure from the fetal scalp on the uterine cervix, which may assist in dilating the cervix.

However, data supporting this procedure is uncertain. While some studies have produced data supporting the practice, others suggest that it does not accomplish any of these outcomes. A meta-analysis suggests that amniotomy to shorten spontaneous labour does not produce a discernible difference compared to no amniotomy. Nevertheless, when there is a delay in labour, the meta-analysis suggests a modest reduction in the rate of caesarean section when the rupture of membranes in conjunction with oxytocin is used as an early intervention.

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