Amniotomy quickens cerival dilation?

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 [email protected]!

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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