Withdrawal of fluid from the amniotic sac to obtain fluid and cells for a variety of tests.Usually performed using ultrasonographic guidance to reduce the risk of fetal loss.
Indications: Determine the presence of genetic diseases (e.g., Down syndrome, Tay-Sachs), any fetal structural abnormalities (neural tube defects), fetal lung maturity, or intrauterine infection (i.e., chorioamnionitis)
Risks : 0.5% risk of fetal loss because of bleeding, infection, preterm labor or fetal injury.
2. Cerclage
It is the placement of a suture into and around the cervix to hold it closed. It is usually performed between 12 and 14 weeks and removed before labor begins.
Indications: Used to prevent cervical opening in an incompetent cervix and prevent preterm delivery or miscarriage.
Benefits: It is controversial whether a cerclage reduces the likelihood of a preterm delivery.
3. Cesarean delivery
It is the delivery of the fetus by making an incision through the abdomen and uterus. The incision can be made in two ways:
- (1) Classical midline longitudinal incision
- (2) Lower uterine segment section—transverse cut above the bladder; more commonly used and less bleeding
Benefits/Risks: The mortality rate is less than vaginal delivery however, complications include postoperative adhesion, infection, and problems with the next pregnancy like placenta previa, uterine rupture.
4. Chorionic villus sampling (CVS)
A small cannula is passed through the cervix or transabdominally, and villus cells are aspirated for genetic analysis. It is usually performed in early pregnancy to allow earlier decision making regarding possible pregnancy termination.
Indications: Cells are taken for genetic studies. Usually reserved for patients with a greater than 0.5% chance of having an abnormality in the fetus.
Risks: 0.5% risk of fetal loss.
5. Episiotomy
It is a surgical incision made through the perineum to widen the vagina and facilitate delivery.
Indications: Used when there are signs of fetal distress while in the vaginal canal, when the baby’s head or shoulders are too large to pass, to lessen perineal trauma and reduce postpartum pelvic floor dysfunction.
6. External cephalic version
It is the application of constant gentle pressure (between 36 and 39 weeks) to the abdomen of the mother with a breech fetus to place it in cephalic presentation.
Success rates are from 50–75%. Fetal monitoring is advised after the procedure as well as administration of Rh-immune globulin to Rh negative women.
7. Fern test (amniotic fluid crystallization test)
Vaginal secretion from the posterior vaginal pool is collected with a sterile swab and placed on a clean slide to dry. To be used in conjunction with the Nitrazine test (pH test to determine presence of amniotic fluid. pH paper will turn blue, demonstrating an alkaline pH)
Indications: It detects ruptured membranes or the leakage of amniotic fluid from the membranes surrounding the fetus during pregnancy. It is helpful to diagnose premature rupture of membranes. If positive, the amniotic fluid will form a fernlike pattern of crystallization.
8. Forceps delivery
It is an instrument applied to the fetal head used for assistance in vaginal delivery.
Four types of forceps are classified as outlet, low, mid, and high depending on the station of the fetal head. High forceps is not recommended by American College of Obstetricians and Gynecologists
Indications: Used to provide traction to augment and/or direct the expulsive forces during the second stage of labor (i.e., prolonged second stage of labor)
Maternal complications: lacerations of the cervix and birth canal, blood loss, and hematomas
Fetal complications: bruising, cephalohematomas, facial and head lacerations
9. Pelvimetry
It is the assessment of the size of the female pelvis in relation to the space needed for the birth of a baby. It has been used to determine whether a natural or vaginal delivery is possible, or whether a caesarean delivery is indicated. Can be performed by physical exam, radiography, or MRI
10. Vacuum extraction
It is a suction cup device that is applied to the fetal head to help in delivery.
Indications: To help shorten the second stage of labour when there is maternal fatigue and fetal distress.
Complications: Less complications as compared to forceps delivery, but hematomas and abrasions to the fetal scalp can occur.
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