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Obstetrics > Induction, Augmentation and Dystocia > Flashcards

Induction, Augmentation and Dystocia Flashcards

1
Q

Define Induction

A

the initiation of contractions in the pregnant patient not in labor before spontaneous labor; from 0cm/no contractions.

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2
Q

Define augmentation

A

enhancement of contractions in the pregnant patient already in labor. Get contractions stronger, longer, and closer together.

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3
Q

Define cervical ripening

A

use of pharmacological or other means to soften, efface and/or dilate the cervix to increase likelihood of vaginal delivery when induction is indicated

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4
Q

True or false: the goal of cervical ripening is to begin contractions

A

False - to get cervix in position for labor

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5
Q

Typical position of cervix at onset of labour

A

50% effaced and 2cm dilated

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6
Q

Describe a ripe cervix

A

shortened, centred/anterior, softened and partially dilated

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7
Q

In general, what are the indications for induction/augmentation

A

Any reason that an improved outcome would occur with baby coming sooner

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8
Q

Examples of induction/augmentation indications

A

§ Post-term Pregnancy (41+ or more weeks gestation /w confirmed dates)
§ Hypertensive disorders (pre-eclampsia)
§ Diabetes mellitus
§ Significant maternal disease not responding to treatment
§ Significant, but stable antepartum bleeding
§ Chorioamnionitis: infection between layers of amniotic sac
§ Oligohydramnious
§ Suspected fetal compromise
§ Rh Isoimmunization at / or near term
§ IUGR
§ PROM (labor onset not occurring 12-24h post rupture) at or near term (esp if GBS positive)
§ Intrauterine fetal death/Intrauterine death in previous pregnancy
§ Advanced age
§ Logistical concerns r/t vicinity to hospital

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9
Q

What does the SOGC recommend as a requirement for induction of labor?

A

Obstetrical/Medical Indication
- PROM before 41 weeks
- HTN
-IUGR

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10
Q

What is the SOGC guideline for induction of post-mature pregnancies?

A

At or after 41 weeks in the absence of any other health concerns

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11
Q

What are the maternal risks of post-term delivery?

A

All related to macrosomia

  • increased chance of c-section
  • dystocia
  • birth trauma
  • PPH
  • infection
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12
Q

What are the fetal risks for postterm delivery?

A

Macrosomia (large fetus), shoulder dystocia, brachial plexus injuries, low APGAR, post maturity syndrome, cephalopelvic disproportion

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13
Q

What occurs to the post term placenta?

A

As placenta ages its perfusion decrease and it is less efficient at delivering oxygen and nutrients

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14
Q

What occurs to postterm amniotic fluid?

A

volume declines after 38 weeks increasing risk for cord compression

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15
Q

What is there an increased risk for regarding meconium in postterm delivery?

A

The longer the fetus is inside, the more likely they are to pass meconium, increasing risk for aspiration

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16
Q

Why is G5 or higher caution for induction?

A

o Can be very sensitive to induction; baby come very quick

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17
Q

Why is vertex not fixed in pelvis caution for induction

A

Worried about cord prolapse r/t head in improper position

Possible dystocia

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18
Q

What regarding the cervix is a caution for iduction

A

Unfavorable/unripe

  • ripening needs to occur first
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19
Q

Why are brow/face presentation cautions for induction?

A

The diameter of the presenting part through cervix is large

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20
Q

Why is over-distention of the uterus a caution for induction?

A

Muscle may be hypersensitive and be overstimulated and increase risk of PP hemorrhag

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21
Q

Why is a lower segment uterine scar an extreme caution for induction?

A

You can labour with a LS scar, but adding induction can increase

Risk of rupture

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22
Q

In general, what are contraindications to induction

A

Any contra-indication to vaginal delivery

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23
Q

What Bishop score is predictive of success?

A

7 or greater

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24
Q

What 6 factors does the bishop score assess?

A

dilatation, effacement, length, consistency, position, station

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25
Q

Bishop Score Dilatation 0, 1, 2

A

0, 1-2, 3-4

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26
Q

Bishop Score Effacement 0, 1, 2

A

0-30, 40-50, 60-70

27
Q

Bishop Score Length, 0, 1, 2

A

> 3, 1-3, <1

28
Q

Bishop Score Consistency, 0, 1, 2

A

Firm, medium, soft

29
Q

Bishop score position 0, 1, 2

A

posterior, mid, anterior

30
Q

Bishop score station, 0, 1, 2

A

-3 or above, -2, -1/0

31
Q

What methods are used to prevent IOL/stimulate so IOL doesn’t have to occur?

A

Nipple stimulation - oxytocin release
Sex - semen has prostaglandins/pressure on cervix
Enema/Oil - increases motility
Stripping/Sweeping membranes
Prenatal hand expression

32
Q

3 General Methods of IOL

A
  1. amniotomy
  2. mechanical dilation
  3. pharmacological
33
Q

What is stripping/sweeping membranes?

A

Mechanical seperation of membranes from cervix/uterus (non-pharm induction method)

34
Q

2 physiological effects of stripping membranes as induction method

A
  1. seperates membranes
  2. enhances prostaglandin release for ripening
35
Q

3 Mechanical Dilation Methods for IOL

A
  1. foley
  2. CRB
  3. laminaria
36
Q

How does laminaria induce labor?

A

Seaweed has massive capacity to absorb fluid and swell up, forcing cervix ope

37
Q

Why would a patient undergo an amniotomy?

A

Augmentation or induction when a patient is committed to delivery (not going home)

38
Q

Considerations for an AROM

A
  • patient will not be going home
  • need fetal/contraction monitoring
  • rx for infection and cord prolapse
39
Q

Besides induction/augmentation, when else would an AROM occur?

A

Whenever fetal access is necessary
- obtain fetal scalp blood sample for pH monitoring
- apply internal scalp electrode

40
Q

What is the ideal pharmacological method for cervical ripening?

A

Prostaglandins

41
Q

What 2 general mechanisms of actions occur regarding the pharmacological management of induction/augmentation

A
  1. cervical ripening - prostaglandin
  2. uterotonic - oxytocin
42
Q

What is prostin?

A

Prostaglandin gel inserted into posterior fornix of vagina for cervical ripening

43
Q

Considerations of prostin use?

A

Gel
Risk is less reversible, harder to remove gel if contractions are too long, strong, with no time inbetween

44
Q

What is cervidil?

A

Prostaglandin vaginal insert into posterior fornix for slow continuous release - patient can go home and remove when contractions are occuring at correct rate

45
Q

What is misoprostol/cytotec?

A

Prostaglandin synthetic tablet (oral/vaginal) for induction

Oral recommended so titration can occur

46
Q

Besides induction, what else is misoprostol/cytotec indicated for

A

Anti-ulcer agent, PPH prevention

(Induction is off label use)

47
Q

Prostaglandins are used for: Whereas oxytocin is used for:

A

Induction

Induction AND augmentation

48
Q

Half life of oxytocin and benefit?

A

Half-Life is ≈ 1-6 minutes

Short half-life, if something isn’t occurring as desired can turn off continuous infusion and effects will be immediate

49
Q

How is oxytocin for induction/augmentation administered and special considerations?

A

Secondary line at proximal port

§ Prime line with mixture because it takes 19.6ml to prime secondary line, running at 2ml an hour – only getting NS

50
Q

True or false oxytocin is effective on cervix

A

False, ripening should occur first

51
Q

Nursing Care for Oxytocin Induction

A
  • continuous observation
  • contractions and FHR q15
  • maternal VS q15-30
52
Q

What is the major thing your are assessing for during oxytocin induction?

A

Tachysystolic uterine activity through assessment of resting tone and FHR to assure there is no reduction in blood flow

53
Q

If tachysystolic contractions occur during oxytocin administration, what would occur?

A

Decrease titration

54
Q

What can tachysystolic uterine contractions cause?

A

placental abruption, fetal hypoxia, precipitous delivery, postpartum hemorrhage/uterine atony

55
Q

Interventions for tachysystolic uterine contractions

A
  • Re-position (Left lateral, side to side, knee chest)
  • Reduce uterine stimulation:
  •  or stop oxytocin
  • remove cervidil
  • swab out prostin
  • Continue monitor
  • Administer ordered tocolytic if indicated
  • Provide support and reassurance
  • Consider O2 and IV bolus if indicated
56
Q

Why is the risk for PPH increased following oxytocin administration?

A

Uterus becomes reliant on steady source of oxytocin to contract - failure to contract leading to subinvolution

57
Q

What dystocias can occur regarding “powers”

A
  1. hypertonic uterine dysfunction: uterus contracts too frequently/strongly making it difficult/not allowing enough time for cervix to dilate and baby to descend
  2. Hypotonic uterine dysfunction: uterus not contracting strongly enough
  3. Precipitate labor: rapid labor
58
Q

Define dystocia

A

difficult or obstructed or non progression labour

58
Q

What dystocias can occur regarding the “passageway?”

A
  1. Pelvic contraction
  2. Obstructions in maternal birth canal
58
Q

What dystocias can occur regarding the “passenger?”

A
  1. breech/shoulder presentation
  2. cord prolapse
  3. persistent occiput posterior position
  4. face/brow presentation
  5. macrsomia
59
Q

What is labor dystocia?

A

Non progression in active labor

60
Q

What interventions occur for labor dystocia?

A

Amniotomy or oxytocin

61
Q

When labor dystocia occurs, what interventions increase likelihood of vaginal delivery?

A

Those done in ACTIVE labor

62
Q

When labor dystocia occurs, what interventions increase likelihood of c-section?

A

when done for slow progress in latent/early labour
* Early/latent labour is SLOW

Obstetrics (12 decks)

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