Hi Everyone! I am a labor and delivery nurse in a rural hospital seeking information from all of you experienced L & D nurses out there....

Please speak to the concept of the benefit of amniotomy to the length in time of cervical dilation.

Do you find that AROM artificial rupture of membranes helps to faciliate cervical dilation? If so, please give rationale/reasons.


Please offer your insights on this matter. I am seeking an ongoing communication regarding this matter and will check back frequently.....THANKS IN ADVANCE!
Alisa, RN

kday!

Thanks for a great reply....why do you find that AROM works well in latent labor of multips? the cervix is naturally more favorable?

Also, off the subject, I notice you are from NC...we are thinking of moving there this summer...how do the jobs look there for L&D nurses, pay rate,etc...also what about the state in general....we are thinking about durham area for duke law....thanks in advance......also my private email is yamo@wsu.edu.....THANKS!

[HazeK]

advantage of AROM:
-direct FSE/IUPC monitoring
-able to assess color of fluid (making preparations if mec stained, rather than rude last-minute surprises)
-increased release of prostaglandin by the cervix now being stretched by the firm presenting part rather than the bag of waters

Disadvantage of AROM:
-increased risk of chorioamnionitis as sterile barrier is now breached
-decreased fluid 'cushion' for umbilical cord, possibly resulting in more var. decels
-if done too early when pt NOT in active labor, labor may last longer than the "24-36 hr ROM window" that most OBs/Peds are comfortable with
-early ROM may affect proper descent/rotation of fetus in the pelvis...the fluid acts as a cushion, a lubricant, etc.
(think how many OP primips you see that are SROM'd....) may be increasing risk of c/s for malpresentation/arrest of descent.

If MD asks me to AROM early in an induction, on an unripe cervix or a primip, my response is "So, you are commited to agressive labor management of this patient and delivery within the next 18-24 hours?" Often at that point they will discuss whether a cervical ripening agent like Prepidil, Cervidil or Cytotec would be appropriate!!!!

Hope that helps!
Happiness!
Haze :-)

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