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IUPC INSERTION AFTER ARTIFICIAL
RUPTURE
OF MEMBRANES
Many clinicians are aware of the risks of
placement outside the amniotic membranes (extra-ovular placement).
Hence, clinicians often ask if certain circumstances can predispose to or
prevent extra-ovular placement.
Intrauterine pressure monitoring requires rupture of the amniotic
membranes before placement of the catheter. Caution must be taken in
any situation when these membranes are not ruptured fully.
Incomplete rupture of the membranes can occur with spontaneous or
artificial rupture of membranes.
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It is common with spontaneous
rupture of membranes to observe intermittent positive signs of rupture
such as the “fern sign”. Most clinicians attribute inconsistent
signs of rupture of membranes to a “high leak”. In other words,
the fetus, through descent or other fetal movements, effectively closes
off that incomplete rupture (leak). Artificial rupture of membranes
using a spiral electrode may also produce a relatively small puncture in
the membranes. If membranes are partially ruptured or only
punctured, intrauterine pressure catheters can easily be advanced outside
the membranes with associated risks of amnioinfusion outside the
membranes, inaccurate uterine contraction waveform, and even placental
disruption. When there is question of
the size of the tear in the membranes, clinicians should attempt to
increase the size of the rupture at the cervical opening. This is
accomplished by digitally rubbing against the membranes. If a spiral
electrode is present, the electrode can be used as a central point to pull
the membranes against taking care to not dislodge the electrode or enlarge
the fetal scalp puncture created by the spiral electrode.
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Intra-amniotic placement of the Koala
IUPC is assessed clinically through visualization of amniotic fluid
flashback within the outer clear lumen.(Lind reference) Other
catheters are opaque. The clinician cannot assess flashback with an
opaque catheter.
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The Koala® Intrauterine Pressure System is
equipped with features that help to ensure proper placement in the
amniotic sac. The Koala is the only IUPC on the market that has a
clear lumen. This makes it possible for the clinician inserting the
catheter to see the amniotic fluid flashback inside the catheter. If
no fluid is seen, then catheter placement is unknown. Or if blood is seen, it is an indication that the catheter is
improperly placed, and can be removed and redirected to a more appropriate
position.
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This Month's Winners
Winners chosen at random from all names enrolled in
Insights program.
 |
| Helen Banister, Collegeville, PA |
| Mollyn Bohnen, Klamath Falls, OR |
| Cathy Emeis, Colorado Spring, CO |
Prize: Essentials Of Fetal
Monitoring by Michelle Murry |
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