Induction and Augmentation Flashcards
Induction vs augmentation?
I- initiation of contractions when uterus isn’t contracting, its the articulation initiation of labour before spontaneous onset
A- enhancement of contractions in pregnant pt already in labour (like using oxytocin)
What is cervical ripening?
Use of pharmacological agent to soften/efface/dilate cervix to increase likelihood of vaginal delivery. More natural way to start labour
When should you induce labour?
Overdue/late term pregnancy (more than 41 weeks) but should do cervical ripening first. Must have a medical reason before inducing labour before 41 weeks (aka HTN, IUGR, premature ROM).
Risks of late term?
Client gets bigger/increased risk of shoulder dystocia, increased risk of PPH, increased LGA baby. Have decreased placental perfusion, increased risk of meconium, less amniotic fluid (risk of cord compression)
Contraindications to induction?
- Placenta previa (over cervical opening)
- Cord prolapse
- Fetal malpresentation (transverse lie or breech)
- Hx (previous uterine surgery, having a C/S, cephalic pelvic disproportion, pelvic abnormalities, active genitalia herpes, and obs/medical conditions)
- Convenience
Bishops score and r/t induction?
Bishops score developed r/t inducing someone. Says a cervix that’s soft/effaced is importunate factor for successful induction. If client has score <6 then you need to use cervical ripening agents first before inducing. If score >7 then you can have a successful induction.
Methods for IOL?
Nipple stimulation, sexual inter course, acupuncture, enema (used to be used for all pt coming in, not anymore), strip/sweep membranes. Amniotomy (artificial ROM), mechanical dilation via foley/ripening balloon/seaweed. Pharmacological (cervical ripening, uteronics- oxytocin)
What is stripping/sweeping of membranes?
Use sterile gloved finger and sweep finger around inside of cervical opening to separate the membrane from cervical opening. This causes prostoglandins to be produced and cervical softening begins. Minimal risks and doesn’t require monitoring/assessments.
What is mechanical dilation types?
- Foley- put catheter in cervix and inflate balloon to dilate, risk- may fall out
- Cervical ripening balloon- 2 balloons (one inside cervix and other in the birth canal), they mechanically force cervix to open
- Laminaria (seaweed)- put sticks of seaweed up there and they help soak up fluid, rarely used
What is amniotomy?
It’s an artificial ROM done by a trained HCP. It’s done to augment/induce labour (inducing not recommended unless combined with other method).
3 types of prostroglandins?
Prostin- type of gel, dose is 1-2 mg, insert into posterior fornix of vagina
Cervidil- vaginal insert of 10 mg into posterior fornix and slowly releases the medication
Misoprostol/cytotec- 50 mcg oral tablet or 25 mcg vaginally used for cervical ripening
Advantages of prostaglandin induction?
Less invasive and more physiologically like labour, simple administration, cervidil (can go home post insertion),
Oxytocin infusion (uterotonic)?
Used for induction and augmentation and has no effect on cervix (so need bishop score >7). Given IV pump as secondary line with independent double check. You gradually increase every 30 minutes.
Nursing care for oxytocin induction?
Assess VS and EFMx20 min prior initiation. Continuous EFM and assess contractions/FHR q15 min and assess client VS q15-30 min.
What is tachysystole?
Excessive uterine activity often with atypical/abnormal FHR. Causes 5+ contractions/10 minutes, resting period between contractions <30 seconds, high resting tone (firmer), contraction lasts >90 seconds
How can tachystytole have an affect on the uterus?
Causes placental abruption (decreased blood flow) fetal hypoxia, precipitous delivery, PPH, PP uterine atony
Intrauterine resuscitation interventions?
Reposition client (left lateral side), decrease/stop oxytocin, check VS of pt, pause pushing efforts, intimate continuous EFM, correct hypotension if present (admits IV fluids), vaginal exam (rule out prolapse), administer tocolytic if indicated, O2 for maternal hypoxia
Complications of induction/augmentation?
Failure to establish labour, tachysystole, chorioamnionitis (infection), uterine rupture, PPH, longer hospital stay, placenta implantation abnormalities in the future, increase risk for assisted vag delivery/C section, and adverse baby outcomes with pre-term birth
After delivery using induction?
Watch for sings of PPH an consider starting oxytocin to help uterus contract for involution and placental separation
Causes of dystocia (difficult delivery) under each 5 Ps?
- Powers- precipitate labour, hyper or hypotonic uterine dysfunction
- Passageway- pelvic contraction, obstructions in birth canal
- Passenger- breech/shoulder dystopia, cord prolapse, face/brow presentation, occiput posterior position
- Psyche- psychological distress
- Positioning- patient mobility
