Class 6: Induction & Augmentation Labor Flashcards
what is induction of labor
- chemical or mechanical initiation of uterine contractions before their spontaneous onset for the purpose of bringing about the birth
what is augmentation of labor
- the stimulation of uterine contractions after labor has started spontaneously but progress has been unsatisfactory
what is elective induction of labor
- when the pregnant person wants to be induced
- not typically allowed
what are risks of elective induction (3)
- increased incidence of c-section
- neonatal morbidity
- and costs
what are indications for labor induction (14)
- pre-eclampsia >37 weeks
- signif antepartem hemorrhage (placental abruption, NOT previa)
- chorioamniotitis
- suspected fetal compromise (ex. poor BPP score, poor doptone analysis)
- term prelabor rupture of membranes with maternal GBS colonization
- postdates
- uncomplicated twin pregnancy >38 weeks pregnancy
- diabetes
- alloimmune disease
- IUGR
- oligohydramnios
- gestational HTN > 38 weeks gestation
- intrauterine fetal death
- PROM near or at term (GBS negative)
if membranes rupture, will give pregnant person 24 h to go into labor unless… (2)
- GBS positive
- signs of infection
what is a contraindication for induction
- placenta previa
- other factors that contradict general labor
what is used to help us determine when to start an induction?
- bishop score
what does the bishop score determine?
- when the cervix is favorable for induction –> identify cervical ripening (softening)
what can be given to promote cervical ripening
- chemical agents (prostaglandins)
- mechanical and physical methods (balloon catheter)
what are 2 prostaglandin gels that are inserted into the posterior part of the vagina
- prostin
- prepadol
what is a postaglandin topical agent attached to a string that can be pulled out of the vagina if strong labor is accidentally induced
- cervadil
prostaglandins can cause..
- induction, but rare
what is required monitoring after admin of a cervical ripening agent
- continuous fetal monitoring for 1 hr
describe use of a balloon catheter for cervical ripening
- balloon inserted into the uterus
- pokes the amniotic membranes which are closely laid against cervix
= triggers release of prostaglandins - keep inflated balloon in cervix for 24 h or will fall out on its own as cervix dilates
when do we not admin prostaglandins for cervical ripening? why?
- in someone has PROM –> prostaglandins already present
what is amniotomy
- artifical rupture of membranes
amniotomy may be done to…
- augment labor in combo w oxytocin
describe nursing care/assessments w amniotomy (5)
- hygiene (changing of pads, etc.)
- FHR (concern of prolapse)
- assess temp q2h
- assess for S&S of infection
- assess characteristics of amniotic fluid
the mother should be.. (2) for an amniotomy to occur
- HIV negative
- no active herpes
what is oxytocin
- hormone normally produced by posterior pituitary gland
- stimulates uterine contractions
oxytocin is used to…
- induce labor or augment a labor progressing slowly bc of inadequate uterine contractions
- used following birth to control postpartum bleeding
what is the goal of using oxytocin for augmentation/induction of labor
- want adequate contractions @ lowest possible dose –> start low and slow
what is the concern w admin of oxytocin
- tachysystole
what are indications for oxytocin (9)
- suspected fetal jeopardy
- inadequate uterine contractions, dystocia
- prelabor rupture of membranes
- post-term pregnancy
- chorioamnionitis
- maternal medical conditions
- gestational HTN
- fetal death
- augmentation of labor
what are contraindications for oxytocin (9)
- cephalopelvic disproportion
- prolapsed cord
- transverse lie
- abnormal FHR (can make worse)
- placenta previa or vasa previa
- prior classic uterine incision or other uterine surgery (worried abt incision line)
- active genital herpes infection
- invasive cancer of cervix
- previous uterine rupture
what type of monitoring should be done w use of oxytocin
- EFM
in addition to tachysystole, what is there a risk of w use of oxytocin
- postpartum hemorrhage –> d/t uterus getting tired = can’t contract as well
what is augmentation of labor
- stimulation of uterine contractions after labor has started spontaneously but progress is unsatisfactory
augmentation of labor is implemented for mngmt of…
- hypotonic uterine dysfunction
what are common augmentation methods (2)
- oxytocin infusion
- amniotomy
no prostaglandins, already have from ROM
