# manually rupturing the amniotic sac



## jordanfstop (Nov 13, 2007)

a situation came up tonight in class whether to manually rupture the sac or not during prehospital child birth. in class our instructor told us to rupture it with the amniohook in our OB/GYN kit. first off, we don't CARRY those hooks! even when the CIC opened her OB/GYN kit there wasn't one in hers. i was told by two well respected paramedics after a call that we never manually rupture the sac because it could have some complications with the umbilical cord. about this call we were on- the mother was dilated at appx 7cm with the amniotic sac crowning (has not yet broken) with the head pushing against it coming out of the vagina every time the mother pushed. the medics said that they can't manually rupture it; a few minutes later it manually ruptured. after i post this, i'll go look in my NYS BLS protocol book to see if anything is mentioned.


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## jordanfstop (Nov 13, 2007)

Hm. NYS EMT-B BLS Protocol (Special Considerations - Emergency Childbirth) SC - 3 Page 2 Section II Line B. states "If the amniotic sac has not broken, use your finger or a clamp to puncture the sac and pull it away from the infant's head and mouth as they appear."


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## Ridryder911 (Nov 14, 2007)

Usually, the membrane will rupture (if it has not yet) during delivery. I personally would never recommend it, unless imminent delivery is for certain. Rupturing the membranes to soon, can cause premature labor as well now can cause infection, and yes delivery has to be performed then. 

I personally have never seen or heard of amio/hook in the field or even ER. Nor would I ever endorse such. Inserting a hook device, especially into the birth canal during contractions is asking for nothing bu trouble.

R/r 911


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## triemal04 (Nov 14, 2007)

jordanfstop said:


> Hm. NYS EMT-B BLS Protocol (Special Considerations - Emergency Childbirth) SC - 3 Page 2 Section II Line B. states "If the amniotic sac has not broken, use your finger or a clamp to puncture the sac and pull it away from the infant's head and mouth as they appear."


Sounds like in that case that the head has allready been delivered.  At that point, you really don't have a choice in the matter; get it out of the way.  Shouldn't be a problem, unless of course you don't do it.  Beyond that...if they're talking about before the delivery of any portion of the kid...gonna say no.  No way in fact.


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## seanm028 (Nov 14, 2007)

Our instructors told us that if the head has already come out or is coming out and the sac is visible over the infant's head, you should rupture it and remove it from the head.  Otherwise, leave it.

So basically, what your book said.  Just giving it a +1.


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## Onceamedic (Nov 14, 2007)

a woman dilated to 7 should not be pushing...  Rupturing the bag may help efface the cervix (the head is harder than a fluid filled bag) but at a 7 dilation I would think there was time to get the patient to the hospital and let the OB/GYN worry about whether or not to rupture the bag.


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## fyrdog (Nov 14, 2007)

If you have any question contact medical control (Doctor) on the radio and describe what you see. 

Personally if the head is presenting in the sac it needs to be ruptured. If the Sac is prolapsed and you don't see the head best leave it be.


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## TKO (Nov 14, 2007)

In pre-hospital birthing emergencies there is only one thing you need to remember:

_"DON'T PUSH!!!  DON'T PUSH!!!  DON'T PUSH!!!"_ and transport.

And if they are compelled to push anyway, then you're not going anywhere.


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## jordanfstop (Nov 14, 2007)

I guess I never made my statement clear; this scenario was with the head _not coming out of the mother yet._ The sac would partially come out and you'd see the come up against the sac. I'm pretty sure on my answer now. Never pop it unless the head is actually out. If the head is out then you can do it.


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## Ridryder911 (Nov 14, 2007)

jordanfstop said:


> I guess I never made my statement clear; this scenario was with the head _not coming out of the mother yet._ The sac would partially come out and you'd see the come up against the sac. I'm pretty sure on my answer now. Never pop it unless the head is actually out. If the head is out then you can do it.




As I described rupturing the membranes can precipitate premature delivery, as well as a source for infection. Never rupture the membranes just because they are presented. 

R/r 911


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