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Amniotomy, also known as artificial rupture of membranes (AROM) or colloquially known as "breaking the water," is the intentional rupture of the amniotic sac by an obstetrical provider. This procedure has several indications and is commonly performed during labor management. This activity reviews the indications, contraindications, and techniques involved in performing an amniotomy and highlights the role of the interprofessional team in the monitoring of the fetus and the mother. Objectives: Describe the indications for an amniotomy. Identify the technique involved in performing an amniotomy. Review the complications associated with amniotomies. Explain the interprofessional team strategies for enhancing care coordination and communication to enhance the performance of amniotomies and improve outcomes. Access free multiple choice questions on this topic.

Amniotomy, also known as artificial rupture of membranes (AROM) and by the lay description "breaking the water," is the intentional rupture of the amniotic sac by an obstetrical provider. This procedure is common during labor management and has been performed by obstetrical providers for at least a few hundred years. The reasons for the intentional rupture of the amniotic sac during labor are multifold and include, but are not limited to, influencing the speed of labor, allowing for more direct monitoring of fetal status, and qualitative assessment of the amniotic fluid.

Complications also are relatively few. The rupture of membranes does eliminate the primary barrier between the fetus and the polymicrobial environment of the vagina. If performed too early in the labor process, there can be an increased risk of intrapartum chorioamnionitis. The most common complication of artificial rupture of membranes is prolapse of the umbilical cord. This invariably occurs after rupture if artificial rupture of membranes is performed when the head is not engaged in the maternal pelvis. In the case of an unengaged fetal head, the rupture of membranes may allow for the umbilical cord to precede the fetal head when the release of amniotic fluid occurs. This will allow the fetal head to compress the section of the umbilical cord preceding the head, generally leading to fetal bradycardia and necessitating emergency cesarean section. This complication should be an easily avoidable, iatrogenic cause of emergency delivery.[8]

Amniotomy, also known as artificial rupture of membranes (AROM), is best performed by an obstetric clinician or a midwife in the labor and delivery department. Prior to the procedure, the nurse needs to assist the provider by preparing the necessary equipment, monitoring the vital signs of the patient, and reporting any untoward changes to the care provider. The nurse plays a vital role during the procedure in monitoring the mother as well as the fetus; they also note the color of the draining amniotic fluid and document the findings in the medical chart. After the procedure, they assess the maternal temperature every two hours and watch for any signs of infection. The nurse also monitors the fetal heart rate via continuous electronic fetal monitoring and communicates the findings to the provider. The nurse needs to frequently change underpads. One of the most crucial roles of the nurse is to educate the woman about the amniotomy procedure and address the patient's concerns at all times. Only through interprofessional collaboration and integration can the best standard of care for both the mother and the fetus be achieved.

The nurse has an important role in the assessment and continuous monitoring of pregnant women in labor. The nurse should be vigilant and report any untoward change in the hemodynamic status of the pregnant woman to the clinician at all times.