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NURS787 Exam 3 > Induction and Augmentation of Labor > Flashcards

Induction and Augmentation of Labor Flashcards

1
Q

List maternal indications for IOL

A

1) DM
2) renal disease
3) chronic pulmonary disease
4) cholestasis of pregnancy
5) gHTN or pre-eclampsia w/out severe features @ 37w
6) pre-eclampsia w/ severe features = ASAP
7) >41w GA - recommended at 42w0; indicated at 42w6d
8) chorioamnionitis
9) PROM after 34w

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2
Q

List fetal indications for IOL

A

1) IUGR
2) isoimmunization
3) non-reassuring fetal testing
4) multiple gestation
5) oligohydramnios
6) IUFD

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3
Q

What are contraindications to IOL?

A

1) problems of placentation (e.g. previa, prolapse)
2) hx myomectomy entering endometrial cavity
3) classical uterine incision
4) transverse lie
5) Cat 3 FHT
6) active genital herpes
7) elective IOL at <39w

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4
Q

What are maternal clinical considerations prior to IOL?

A

1) valid indication
2) no contraindications to vaginal labor/delivery
3) pelvimetry
4) Bishop score via cervical exam
5) review risks, benefits, alternatives to IOL

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5
Q

What are fetal clinical considerations prior to IOL?

A

1) GA based on final EDD - fetal lung maturity
2) fetal presentation and lie
3) EFW
4) Confirm Cat 1 FHT

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6
Q

What are risk factors for failed IOL?

A

1) nulliparity
2) post-EDC
3) low Bishop score
4) shorter stature
5) higher BMI

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7
Q

Describe Bishop scoring system

A

an assessment of cervical status to determine success of IOL

  • > /= 8 –> favorable cervix
  • =6 –> unfavorable cervix; may require ripening

0: posterior, firm, cervical length >4cm, 0/-3
1: midline, medium, 2-4cm, 1-2/-2
2: anterior, soft, 1-2cm, 3-4/-1 to 0
3: cervical length <1cm, >5cm/+1 to +2

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8
Q

Describe the latent phase of labor according to Zhang’s labor curve

A

regular, q10-20min, uterine ctxns lasting 15-20s –> intensifies to q5-7mins, lasting 30-40s

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9
Q

Describe active labor according to Zhang’s labor curve

A

cervical dilation starts at ~6cm –> ends with complete dilation

  • nullips: 0.5-0.7cm/h or faster
  • multips: 0.5-1.3cm/h
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10
Q

What are the 4 Ps?

A

1) powers
2) passenger
3) passageway
4) psyche

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11
Q

What are considered adequate contractions on pitocin?

A

q2-3mins lasting 60-90s

50-60 peak, 10-15 resting tone

150-350 MVUs

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12
Q

What is therapeutic rest?

A

“treats” prolonged latent phase

morphine sulfate IM +/- phenergan or vistaril

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13
Q

What is dx for protracted active phase?

A

multips: <0.5 - 1.5cm/h
nullips: <0.5 to 1.2cm/h

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14
Q

What is dx for arrest of active phase?

A

6cm or more, ROM, + one of following:

  • 4h+ of adequate ctxn (>200MVU)
  • 6h+ of inadequate ctxn
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15
Q

What is the mean duration of the second stage?

A

nullips: 50-60min
multips: 20-30mins

no max length identified

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16
Q

What is dx for protraction descent?

A

nullips: <1cm/h
multips: <2cm/h

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17
Q

What is dx for arrest of descent?

A

0 descent - time period not officially identified

nullips: 3h
multips: 2h
+1h for epidural

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18
Q

What are risks of >2h second stage?

A

1) low 5 min APGAR
2) increased neonatal depression
3) NICU admission
4) perineal trauma
5) chorio
6) PPH
7) instrumental deliveries

19
Q

What are risk factors affecting length of the second stage?

A

1) parity
2) birth weight
3) OP position
4) BMI
5) epidural anesthesia
6) fetal station at complete dilation
7) delayed pushing

20
Q

What are indications for C/S in the setting of IOL or augmentation?

A

1) >/= 6cm, ROM, and no cervical change over 4h
2) no cervical change in 6h of pit + inadequate uterine activity
3) failed induction = little to no cervical change for at least 24h in setting of pit + ROM

21
Q

List cervical ripening agents

A

1) prostaglandin E2: dinoprostone (Cervidil or Prepidil)

2) prostaglandin E1: misoprostol (Cytotec) off-label

22
Q

What are cervical ripening agents contraindicated?

A

1) prior to 40w GA

2) uterine scarring

23
Q

What is the MOA of prostaglandins?

A

increase submucosal water content of cervix –> dissolution of collagen bundles

24
Q

How should FHT be monitored during cervical ripening?

A

EFM for 0.5-2h

Continue to monitor if regular ctxns continue

25
Q

Prepidil

A

0.5mg gel in 2.5mL syringe q6-12h

max 3 doses = 1.5mg

pit can start 6-12h after last dose

26
Q

Cervidil

A

10mg (0.3mg/h) q6h

max 3 doses = 30mg

pit can start 30-60min after removal

27
Q

Cytotec

A

25mcg per vagina q3-6h

  • mostly likely for vaginal birth w/in 24h
  • most likely for tachysystole

25-50mcg PO q3-6h

  • lowest c/s rate
  • less PPH and better NB outcomes

pit can start 4h after last dose

28
Q

What is Cytotec contraindicated in cervical ripening?

A
  • uterine scars

- >3 ctxns in 10 mins

29
Q

What is a contraindication to dilation w/ balloon?

A

placenta previa; low-lying placenta

30
Q

true or false:

Balloons take longer than prostaglandins to ripen a cervix.

A

false

may even be faster when used w/ another agent

31
Q

What is the mechanism of membrane stripping?

A

releases prostaglandins –> ripening

32
Q

Describe a typical dose of castor oil

A

2oz or 60mL in 2 doses

33
Q

What are the adverse effects of castor oil?

A

DIARRHEA!

–> dehydration - PO 8oz fluids w/ electrolytes q1h

34
Q

List uterotonic agents

A

1) oxytocin (Pitocin, Syntocinon)

2) nipple stimulation

35
Q

contraindications to oxytocin

A
  • inclusive of contraindications to NSVD
  • pulmonary edema
  • inappropriate staffing ratios
36
Q

Why is pulmonary edema a contraindication to the use of oxytocin?

A

oxytocin = antidiuretic

–> inc edema, water toxicity, hyponatremia

37
Q

What steps should be taken in the case of fetal compromise while augmenting with pitocin?

A

1) move to lateral position
2) +/- fluid bolus and terbutaline 0.25mg subQ
3) notify physician
4) restart after 15-30mins of Cat 1 FHT

38
Q

When should oxytocin be discontinued?

A
  • after 10-12h (if not in active labor)

- once active labor has begun

39
Q

How is nipple stimulation performed?

A

roll one or both nipples with fingers OR use breast pump for 2mins, stop for 2mins, etc until contractions begin

40
Q

What is the most common risk of AROM?

A

infection (e.g. chorioamnionitis, endometritis)

41
Q

What is the most severe risk of AROM?

A

cord prolapse

42
Q

What are indications for augmentation of labor?

A

labor dystocia

1) >/= 4h w/out cervical change after 5cm
2) prolonged latent phase

43
Q

When is augmentation of labor contraindicated?

A

1) active phase arrest (>/= 6cm), ROM, no change for 4+hours
2) >/= 6h w/ presence of inadequate contractions
3) inclusive of contraindications for laboring

NURS787 Exam 3 (4 decks)

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