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  • Necessity for internal uterine or fetal monitor when membranes are intact
  • Active management of labor
  • Questionable meconium
  • Induction of labor
  • Hastening labor
  • Malpresentation
  • Cord palpable below or near fetal head
  • Unstable lie
  • Suspected villamentous insertion of umbilical cord
  • Presentation unknown or not fully engaged (relative)—if the head is not fully engaged, the risk for prolapse is increased
  • Cervix dilated <3 cm, or patient not in active labor (relative)
  • Patient refuses (relative)
  • Amniotomy hook or amniotomy glove.
  • Sterile gloves and lubricant.
  • Absorbent pads and towels to be placed under the patient.
  • Fetal monitor.
  • Tocolytics should be available, especially if labor is being augmented.
  • Equipment necessary for the clinician to observe universal blood and body fluid precautions (gloves, gown, drapes, mask, eye protection).

Fetal Presentation

  • Vertex presentation: Cephalic presentation (the head presents first)
  • Malpresentations:
    • Breech: Buttocks present with the legs folded or extended. In an incomplete breech presentation, a foot or leg presents first.
    • Face or brow.
    • Compound: An extremity prolapses beside the presenting fetal part (e.g., a foot in a breech presentation or an arm in a vertex presentation).

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The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Observe the patient and the fetus for signs of distress.
  • Make certain that the cord did not prolapse or that the amniotomy hook did not lacerate the cervix or the infant.
  • Give post-procedure instructions to the patient.
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