Amnioskopiya

Description:

In 1962 E. Saling for definition of a condition of a fruit during pregnancy and in labor offered an amnioskopiya method. The essence of a method consists that by means of the special endoscopic device (amnioskop) examine the lower pole of fetal egg (fetal membranes, amniotic waters and the prelying part of a fruit). At an amnioskopiya estimate color and amount of amniotic waters. So, availability of meconium in waters usually testifies to a pre-natal hypoxia of a fruit. As for diagnosis of an integrity of a bag of waters, usually it is easily carried out at vaginal examonation therefore there is no need to resort to an amnioskopiya. However for the purpose of studying of character of fetal membranes this method has not equal. Amnioskopiya gives the chance to diagnose presentation of loops of an umbilical cord and a low implantation of placenta.

Indications and contraindications to an amnioskopiya:

Indications for an amnioskopiya are: 1) suspicion on perenashivany pregnancies; 2) diagnosis of a condition of a fruit at pregnant women of risk group (a gestosis, the burdened obstetric anamnesis, a serious extragenital illness, elderly primapara, disturbance of cordial activity of a fruit); 3) definition of an integrity of a bag of waters; 4) specification of the prelying part of a fruit; 5) diagnosis of a hemolitic disease (Rhesus factor conflict); 6) suspicion on pre-natal death of a fruit; 7) diagnosis of a condition of a fruit at anomalies of patrimonial activity, long childbirth (at the whole bag of waters); 8) clarification of the reason of a hypoxia of a fruit in labor (presentation of loops of an umbilical cord); 9) plevisty attachment of an umbilical cord (vasa pracvia).

Contraindications to an amnioskopiya: 1) the colpitis, a cervicitis, horioamnionit; 2) placental presentation or suspicion on it.

Technology of carrying out amnioskopiya:

Condition for an amnioskopiya is passability of the channel of a neck of uterus for a tube of the minimum diameter. Now the set of designs of an amnioskop is offered. Most of researchers use амниоскоп conical shape. Character of a light source and its arrangement in an amnioskopa are of great importance. The lighting bulb has to give light deprived of green components of a range (for diagnosis of green coloring of waters). In recent years widely use the fiberscopes radiating "cold light". Amnioskop represents a cone-shaped tube 20-25 cm long with centimetric graduation on an outside surface and mandrin (obturator) inside. Diameter of a tube 12, 16, 20 mm and more. The lighting device joins a tube. To an amnioskop the packer with the long handle for capture of small tampons in case of need of cleaning of a field of vision of slime, blood, etc. is given. In our clinic it is used амниоскоп firms "To. Storz" (Germany). The equipment of an amnioskopiya is simple and is as follows (fig. 1). Pregnant (woman in labor) is stacked on a gynecologic chair. Make processing of external genitals and a vagina, and then vaginal examonation. Some authors recommend also survey of a neck of uterus by means of mirrors. The muddy, greenish mucous stopper of the channel of a neck of uterus in most cases indicates the content of meconium in amniotic waters.
At vaginal examonation define a shape of a neck of uterus, its length, situation, passability of the channel of a neck of uterus that in turn gives the chance to pick up the corresponding diameter of an amnioskop and technology of carrying out an amnioskopiya. There are two essentially various ways of introduction of an amnioskop to a cavity of the uterus via the channel of a neck of uterus: under control of vaginal speculums without capture of a neck of uterus bullet nippers and under control of the fingers entered into a vagina. If in sight of an amnioskop find a mucous stopper, then се it is necessary to remove with a special tupferoderzhatel as it imitates milk color of amniotic waters.

Assessment of results of an amnioskopiya:

In the beginning it is necessary to establish a condition of a bag of waters (it is whole or is absent), existence or lack of the vascular drawing on covers. Further it is necessary to define amount of amniotic waters ("much", "the moderate quantity", is "not enough", "lack of amniotic waters"). After that the attention is concentrated on determination of color of amniotic waters (light, opalescent, mekonialny, yellow, brown). It is necessary to estimate quantity of flakes of syrovidny lubricant (no, the moderate quantity, is a lot of). It is important to establish also degree of an otslaivayemost of covers of the lower pole of a bag of waters (0-1 cm, 2-3 cm, 4 cm and more).
At an amnioskopiya define the prelying part of a fruit (a head, buttocks), and also loops of an umbilical cord and small parts of a fruit (a brush, legs). Color of amniotic waters has the greatest diagnostic value. It is established that this or that their coloring is characteristic of a certain type of obstetric pathology. So, for postmature pregnancy, for a Rhesus factor conflict — yellow, for pre-natal death of a fruit — dark brown the Expressed vascular drawing on covers usually indicates typically green coloring a low arrangement of a placenta, At suspicion on pre-natal suffering of a fruit at the end of pregnancy the amnioskopiya is recommended to carry out at an interval of the 2nd day.
Green coloring of amniotic waters indicates the menacing condition of a fruit, but is not the absolute indication to the emergency operative measure. In such cases childbirth it is necessary to carry out iod monitor a game by the troll. The amnioskopiya in labor is of particular importance. Many authors recommend to all women at revenues to childbirth along with carrying out vaginal examonation to make an amnioskopiya. According to J. Gaal and O. of Pohanka (1971), the positive take of an amnioskopiya in labor is revealed in 8,5% of cases when the menacing state for a fruit was not supposed. Carrying out an amnioskopiya in labor at women of group of high risk is quite justified. At detection of meconium it is necessary to open a bag of waters and in the presence of conditions to take blood from the prelying part of a fruit for definition of an acid-base state and to carry out intensive observation of a fruit in the course of childbirth. At the prolonged first period of childbirth repeated carrying out an amnioskopiya is shown to women in labor with the whole bag of waters. The positive take of data of an amnioskopiya promotes a right choice of tactics of further conducting childbirth. At an amnioskopiya the following complications a rupture of fetal membranes, bleeding (injury of a mucous membrane of the channel of a neck of uterus, placental detachment is more rare), development of an infection in women in labor and newborns are possible.