25. induction and augmentation of labor Flashcards

1
Q

what is induction of labor?

A

a process whereby labor is initiated by artificial means after an appropriate assessment of the mother and fetus. In the case of high-risk pregnancies, induction is necessary to reduce the risk of morbidity to the mother and her fetus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is Augmentation?

A

artificial stimulation of labor that has begun spontaneously but the contractions are inadequate (promote adequate contractions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the maternal indications for induction?

A

Preeclampsia
Diabetes mellitus
Heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the Fetoplacental indications for induction?

A
  • Prolonged pregnancy (postterm)
  • Intrauterine growth restriction (IUGR)
  • Abnormal fetal testing
  • Rh incompatibility
  • Fetal abnormality
  • Premature rupture of membranes
  • Chorioamnionitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the maternal indications for Augmentation?

A
  • Abnormal labor (in the presence of
    inadequate uterine activity)
  • Prolonged latent phase
  • Prolonged active phase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the maternal contraindications for induction?

A
-	Absolute contracted pelvis 
Relative contraindications
-	Prior uterine surgery
-	Prior classic cesarean incision
-	Complete transection of uterus
-	Overdistended uterus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the Fetoplacental contraindications for induction?

A
  • Preterm fetus without lung maturity
  • Acute fetal distress
  • Transverse fetal lie
  • Abnormal presentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

which drug is used for the induction and augmentation of labor?

A
Synthetic oxytocin (brand name Pitocin) 
Administered continuously via IV drip
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

in what dose is Oxytocin given?

A
initial dose (0.5 to 6 mU/min')
time between dose increments (10 to 60 min')
and maximum dose (16 to 64 mU/min').

*While oxytocin is given, continuous monitoring of uterine activity and FHR is indicated so that the dose can be adjusted properly. In addition, maternal blood pressure should be monitored because pitocin may be associated with maternal hypotension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is Bishop score (cervix score)?

A

a pre-labor scoring system that helps to determine the status of the cervix (favorable or unfavorable) for successful vaginal delivery; used in predicting whether induction of labor will be required.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the Bishop score based on?

A

the station of the presenting part and 4 characteristics of the cervix: 1.dilation, 2.effacement, 3.consistency, and 4.position
DECP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how is the Bishop score divided?

A

score ≥ 6 as favorable and a score ≤ 3 as unfavorable; scores of 4-5 are in a gray zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is pre-induction cervical ripening?

A

when the cervical status is unfavorable, a ripening process is employed before induction aiming to shorten the duration of induction and maximize the possibility of vaginal delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the 4 methods for ripening?

A
  1. Prostaglandins
  2. Ballon catheter
  3. Laminaria sticks (osmotic dilators)
  4. Hegar dilator set
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how are prostaglandins used for ripening?

A

Work by inducing cervical remodeling (↑ collagenase activity), cervical dilation, and uterine contractions.
PGE2 gel, PGE2 pessary, or PGE1 (misoprostol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how is a Balloon catheter used for ripening?

A

insertion of Foley catheter (filled by 30-60 mL) into the cervix.

17
Q

how are Laminaria sticks used for ripening?

A

organic/synthetic material inserted into the vagina/cervix, absorbing water, dilating and enlarging in size (resulting in cervical dilation). Usually inserted for up to 24 h’.

18
Q

how is a Hegar dilator set used for ripening?

A

consists of metal rods with increasing size (maximum diameter 26 mm); provides progressive cervical dilation by mechanical means.

19
Q

how is an amniotomy performed?

A

with an ‘amnio-hook’ that is used to puncture the amniotic sac around the fetus and release some of the amniotic fluid.

**After an amniotomy is performed, a careful examination should be taken to ensure that prolapse of the umbilical cord has not occurred