25. induction and augmentation of labor Flashcards
what is induction of labor?
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.
what is Augmentation?
artificial stimulation of labor that has begun spontaneously but the contractions are inadequate (promote adequate contractions)
what are the maternal indications for induction?
Preeclampsia
Diabetes mellitus
Heart disease
what are the Fetoplacental indications for induction?
- Prolonged pregnancy (postterm)
- Intrauterine growth restriction (IUGR)
- Abnormal fetal testing
- Rh incompatibility
- Fetal abnormality
- Premature rupture of membranes
- Chorioamnionitis
what are the maternal indications for Augmentation?
- Abnormal labor (in the presence of
inadequate uterine activity) - Prolonged latent phase
- Prolonged active phase
what are the maternal contraindications for induction?
- Absolute contracted pelvis Relative contraindications - Prior uterine surgery - Prior classic cesarean incision - Complete transection of uterus - Overdistended uterus
what are the Fetoplacental contraindications for induction?
- Preterm fetus without lung maturity
- Acute fetal distress
- Transverse fetal lie
- Abnormal presentation
which drug is used for the induction and augmentation of labor?
Synthetic oxytocin (brand name Pitocin) Administered continuously via IV drip
in what dose is Oxytocin given?
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.
what is Bishop score (cervix score)?
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.
what is the Bishop score based on?
the station of the presenting part and 4 characteristics of the cervix: 1.dilation, 2.effacement, 3.consistency, and 4.position
DECP
how is the Bishop score divided?
score ≥ 6 as favorable and a score ≤ 3 as unfavorable; scores of 4-5 are in a gray zone
what is pre-induction cervical ripening?
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
what are the 4 methods for ripening?
- Prostaglandins
- Ballon catheter
- Laminaria sticks (osmotic dilators)
- Hegar dilator set
how are prostaglandins used for ripening?
Work by inducing cervical remodeling (↑ collagenase activity), cervical dilation, and uterine contractions.
PGE2 gel, PGE2 pessary, or PGE1 (misoprostol)