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Amnioscopy is a prenatal diagnostic examination that is necessary for pregnant women. Diagnosis is carried out in the last weeks of pregnancy (after the 37th week) to track the condition of the fetus. The lower part of the fetal egg is examined using an amnioscope – an endoscopic device with a set of conical tubes, an illuminator and a photo attachment. What you need to know about the procedure, why it is performed, what are the indications / contraindications and results?
General characteristics of the procedure
Amnioscopy is a standard gynecological practice that is used in late pregnancy or just before childbirth. Also, diagnostics are carried out in dynamics every 2 days and in childbirth, provided that the fetal bladder does not burst on its own.
The gynecologist examines the shade, the amount of fluid, the walls of the bladder through the cervical canal using an amnioscope.
The fluid that is being examined protects the fetus from mechanical damage, infections, maintains a constant temperature and acts as a source of nutrients.
Fluid defects (unnatural color / quantity / presence of impurities) indicate the pathology of pregnancy.
Before the examination, a woman must pass a bacteriological examination of the vagina (smear on the flora) and listen to instructions on the upcoming manipulations.
A woman in labor is obliged to inform the doctor about a predisposition to increased bleeding or recent spotting from the genital tract. In such cases, amnioscopy is best avoided so as not to put the health of the mother and child at risk.
A woman in labor is examined on a gynecological chair in a position with her legs brought to her stomach. The gynecologist inserts a special device into the cervix and examines the internal cavity.
In the normal course of pregnancy, a sufficient amount of clear / light amniotic fluid is recorded. Normally, the presence of original lubrication is allowed.
An abnormal amount / shade of amniotic fluid, the presence of various impurities indicates internal disorders and a possible threat to the fetus. For example, oxygen starvation, intrauterine death, hemolytic disease, cardiac anomalies or other obstetric and gynecological abnormalities.
Amnioscopy during pregnancy allows you to determine the general condition of the fetus, which becomes key for further delivery.
The doctor assesses the condition of the baby, the readiness of the mother’s body for childbirth, if necessary, uses emergency methods to save one or two patients.
Amnioscopy is also performed during delivery along with standard vaginal examination. The procedure will help to control the condition of the baby and prevent possible threats.
The procedure is especially informative and appropriate for women in labor who are at risk (age from 35, chromosomal pathologies, the birth of children with serious defects). According to statistics, amnioscopy during childbirth prevents about 9% of dangerous cases when the threat to the child was not previously recorded.
In a separate category, transcervical amnioscopy is distinguished. It is carried out in the first trimester of pregnancy to detect Down’s Syndrome.
To confirm the chromosomal pathology, several more studies are carried out – transabdominal cordocentesis or aspiration. A clear diagnosis can be obtained as early as the 16th week of pregnancy.
Indications and contraindications for the procedure
| Показания | Противопоказания |
|---|---|
| Age of the woman in labor from 35 years | placenta previa |
| Aggravated anamnesis (the birth of babies with chromosomal pathologies or diseases that are subject to prenatal diagnosis) | Colpitis (inflammatory process in the mucous membrane of the vagina) |
| Gene mutations in the mother and/or father of the child | Breech presentation of the fetus |
| Prolongation of pregnancy | Chorioamnionitis (inflammation of the walls of the amniotic sac) |
| Chronic fetal hypoxia | Cervicitis (inflammation in the canal or uterus itself) |
| Ultrasound markers of chromosomal pathology | |
| Various deviations from the norm of development, which are fixed on screening | |
| Fetal pathologies (for example, a violation of cardiac activity) | |
| Suspicion of the death of a child | |
| Rhesus conflict with suspected hemolytic disease |
Diagnostic technique
The doctor is obliged to inform the patient about the indications, the diagnostic technique and the possible risk. In some cases, the written consent of the woman is required for amnioscopy.
Immediately before the procedure, a woman in labor undergoes a standard gynecological examination. She is placed in a special chair, a vaginal examination is performed to determine the patency of the cervical canal and internal os.
The cervical canal is the cervical canal that connects the uterine cavity to the vagina. The cervical canal is divided into internal and external os. The entire canal cavity is covered with a specific epithelium that produces an abundance of mucus.
If necessary, the gynecologist gently expands the internal os with his fingers to assess the condition of the fetus, and then insert the amnioscope. As soon as the cervix is exposed, the specialist inserts the tube with the mandrel into the cervical canal behind the internal os. To do this, use fingers or special mirrors. Mandrin – a rod for closing the lumen of medical instruments (used to facilitate medical manipulations). The size of the tube is varied by the gynecologist, based on the diameter of the cervical canal (from 12 to 20 millimeters).
The doctor carefully removes the mandrin and directs the light into the tube. The light must be positioned in such a way as to obtain a complete view of the lower pole of the amniotic sac.
In some cases, a mucous plug interferes with the examination. It can be carefully removed with a tupfer.
Tupfer – a sterile probe-tampon. Outwardly, it resembles a cotton swab, consists of gauze / cotton wool or other porous materials. Tupfers are used in surgery to dry wounds, to take any biological material with subsequent transportation.
Evaluation of results
First, the doctor assesses the condition of the fetal bladder, examines its integrity and vascular pattern. Next, the amount / shade of amniotic fluid, the presence / absence of flakes of original lubricant is determined. At full-term pregnancy, there is a moderate amount of light-colored liquid with small flakes of original lubricant.
A post-term pregnancy is characterized by an insufficient amount of thick greenish water without flakes of lubricant. Green amniotic fluid with an admixture of original feces indicates fetal hypoxia and disruptions in the functionality of the placenta. The abundance of yellow water indicates hemolytic disease.
An atypical shade of water is not always a reason for surgical intervention. In some cases, it will be necessary to carry out childbirth under monitor control. The main thing is that the woman should not be stressed because of the current situation and listen to the doctor’s instructions. The doctor evaluates the membrane of the fetal bladder. It can peel off by 0,1 – 4 or more centimeters. Further medical manipulations and the daily routine of the woman in labor depend on the information received. Additionally, the specialist fixes the presenting part of the fetus (buttocks/head), small parts (skin/hands) and loops of the umbilical cord.
Possible complications
The side effect of diagnosis depends on a number of factors and can range from minor spotting to premature rupture of amniotic fluid.
The fetal membrane can simply burst, which will aggravate the course of pregnancy and the condition of the baby. Serious internal bleeding is also possible. Most often, the mucous membrane of the cervical canal is damaged, and detachment of the placenta occurs much less frequently. It is also possible to develop an infectious process in the mother and / or baby.
Amnioscopy should be performed only as directed by the attending physician. Do not take into account reviews, videos or information from unverified sources, as it can harm both mother and baby.
Doctors say that complications rarely occur, the main thing is to strictly follow the requirements of specialists and not be stressed. Take care of the safety of the baby and be healthy!