amniotic fluid

Overview of Amniotic Fluid & Its Implications in Nursing Care

Understanding amniotic fluid is crucial for effective nursing care during pregnancy and labor.

Purposes of Amniotic Fluid

  • Cushions the embryo: Provides a protective barrier against physical injuries.

  • Floats the umbilical cord: Prevents compression under normal conditions.

  • Permits growth and development: Allows for the unrestricted growth of the fetus.

  • Keeps uterus distended: Maintains distance between the uterus and fetus, aiding in musculoskeletal development.

  • Acts as a wedge during labor: Facilitates childbirth by aiding the positioning of the fetus.

  • Used for analysis: Can be analyzed to determine fetal health and maturity through various tests.

Amniotic Fluid Quantity

  • Oligohydramnios: Refers to a condition where there is too little amniotic fluid surrounding the fetus.

  • Polyhydramnios (Hydramnios): Refers to an excessive amount of amniotic fluid surrounding the fetus.

Rupture of Membranes

  • Spontaneous ROM: Natural rupture of membranes occurring during labor.

  • Artificial ROM: Clinical procedure to intentionally rupture the membranes using tools like the amniohook.

  • Amniotic sac: The fluid-filled bag that surrounds the fetus.

  • Amniohook: A tool used for artificial rupture of membranes.

Methods of Fluid Evaluation

  1. Nitrazine Test:
       - Tests the pH of the fluid.
       - Yellow indicates negative result, while dark blue indicates a positive result.
       - Conducted by Registered Nurse (RN) or Medical Doctor (MD) / Certified Nurse Midwife (CNM).
       - False positives are possible.

  2. Fern Test:
       - Involves obtaining amniotic fluid from the vagina (usually performed through a sterile speculum examination).
       - Fluid is smeared on a microscope slide and air-dried; it forms a fern leaf-like pattern when viewed under a microscope.
       - Conclusive for rupture of membranes; performed by MD or CNM only.

  3. Amnisure Test:
       - A commercially available test used in Labor and Delivery units for evaluating rupture of membranes.
       - Advantages include the ability for RN to perform this test as part of the assessment if the patient complains of leaking fluid (requires physician order).
       - Sample is obtained with a swab, placed in a test tube, and results are available in minutes.
       - Positive result indicates fetal membrane rupture; negative indicates no rupture.

Role of Nurse

  • Prioritize checking fetal heart rate first.

  • Perform tests to evaluate fluid if necessary.

  • Note the time of rupture, color, consistency, and any foul odor of the fluid.

  • Assess temperature every two hours if there has been a rupture of membranes (ROM).

  • Limit vaginal examinations after ROM to prevent infection.

  • Maintain cleanliness and dryness for the patient by frequently changing peripads and chux pads.

  • Be aware of the station/presenting part of the fetus.

  • Document findings accurately following assessment.

Prolapse of the Umbilical Cord

  • Can occur with rupture of membranes especially if the presenting fetal part (usually the vertex or head) is not well engaged in the pelvis.

  • This can create space for the cord to slip anterior to the presenting part once the water breaks.

  • Compression of the cord can lead to a drop in fetal heart rate and cause severe fetal distress, necessitating an immediate cesarean section (a TRUE EMERGENCY).

Evaluating Fluid

  • Evaluate if the fluid is clear or meconium-stained.

  • Meconium presence indicates fetal stress; actions should be taken accordingly.

Managing Infection Risks

  • Check temperature every 2 hours due to the risk of infection increasing with prolonged ROM.

  • Ascending bacterial infection can lead to chorioamnionitis.

  • A fever of > 100.4°F is a concern that should warrant notification of the healthcare provider.

  • Antibiotic therapy should be started if fever occurs or if the patient has had ROM for over 18 hours (considered prolonged ROM).

Vaginal Exam Guidelines

  • Only sterile vaginal exams are allowed to prevent pushing bacteria up the genital tract.

  • Limit the frequency of vaginal examinations under these conditions.

Ensuring Patient Hygiene

  • Keeping the patient clean and dry is essential; change peripads and absorbent pads frequently.

Monitoring Fetal Station

  • Assess fetal station frequently to avoid the risk of umbilical cord prolapse, especially if the fetus is in a high station.

  • The ischial spine can provide reference points (
    +1, +2, +3 represent the descent of the fetus in relation to ischial spines).

  • If the cord cannot be visualized, it can often be palpated as a mass during vaginal examination.

Documentation Example

  • Proper documentation is critical in nursing care. An example entry may include:
      - "C/o trickle of clear fluid which began at 0900 today. Denies bleeding. Denies contractions or pain. Reports active fetal movement. Fetal heart rate 145 with moderate variability. Positive accelerations. No decelerations. No contractions palpable or seen on monitor. Large amount of clear fluid seen on peripad worn from home and positive fluid seen leaking from the vagina. Nitrazine positive. Temp 98.5. R. Smith, CNM notified of findings."