Induction/Birth variations Flashcards
What is induction of labor?
Stimulation of uterine contractions during pregnancy before labor begins on its own
What is augmentation of labor?
Strengthens and increases frequency of uterine contractions with medications or interventions
What is cervical ripening?
Softening of the cervix that prepares the cervix for labor
Medications or other interventions can be used to ripen the cervix for induction
What are the maternal indications for an induction?
Chronic conditions: DM, HTN, renal, pulmonary, cardiac disease, etc.
Pregnancy related complications: Preeclampsia, PROM, intra-amniotic infection
Other: fetal demise, h/o precipitous labor or extensive distance from hospital (elective)
What does fetal demise in the uterus increase moms risk for?
DIC
Sepsis
Death
What are the fetal indictions for induction of labor?
Fetal compromise: IUGR, oligo, mild abruption, non-reassuring FHT’s
Late term (41 weeks), post term (42 weeks)
What are some reasons mom might elect to have induction of labor?
Suspected large baby
Mother in town and leaving in 2 weeks
2 days after due date
Aching back and swollen feet
Tired of being pregnant
Wanting baby to have specific birth stone, same birthday as Uncle Jim
Caregiver convenience
What gestational age can mom elect to have an induction?
39 weeks
What are the increased risks associated with induction? (6)
Increased chance for cesarean birth (questionable)
Increased epidural use
Postpartum hemorrhage
Oxygen requirements for the baby at delivery
Longer hospital stays
Increased iatrogenic prematurity
What assessment information should be collected for induction?
Confirm presenting part by SVE or US to be cephalic
Collect Baseline Info such as Vital signs (Prostaglandins can raise temp), CTX pattern, FHT’s
Bishop score- determines “ripeness” of cervix
What does a higher bishop score mean? What does a lower bishop score mean?
Higher scores (≥8) associated with greater chance of having a vaginal delivery (cervix favorable/ripe for IOL)
Lower scores (≤6) associated with lower chance of vaginal delivery; prolonged labor (cervix is unfavorable/unripe for IOL)
A score less than 6 is associated with?
Unsuccessful induction
Prolonged labor
Higher risk for c-section
What is cytotec? Use? What is the dose?
Cervical ripening
Misoprostol, prostaglandin
SL: 25-50mcg q 2-4 hours x up to 6 doses in a 24 hour period; useful for PROM/PPROM
Vaginally: 25 mcg q 4 hours x 4-6 doses
When is cytotec contraindicated?
Contraindicated for ripening if history of previous c/s or any other uterine scar
What is dinoprostone? Use? Dose?
prostaglandin E2
Cervical ripening
Cervidil: 1 string per vagina x 12 hours ($218 per dose)
Prepidil: 0.5 mg dinoprostone in 2.5 ml gel q 6-12 hrs x 3 doses ($185 per dose)
What is the goal of cervical ripening?
to improve Bishop score, however, sometimes these interventions are enough to start labor
How can you mechanically ripen the cervix?
Foley bulb (with 60 mls): Falls out when 3-4 cm dilated
Cook balloon (80/50): Squeezes cervix between two balloons and falls out 4-5 cm
Laminaria (Seaweed): See more with IOL for demise
How does a foley balloon work?
makes membranes separate helping with stimulation of own prostaglandins
How does a cook balloon work? Risks?
squeezes cervix and usually falls out on own at 4-5 cm dilated
Risks: cause membranes to rupture, can cause fetus to move up out of pelvis and not be head down anymore, uncomfortable
How does laminaria work? When is it often used?
absorb mucus and expand –> mechanical dilation.
Used more for induction of labor with fetal demise
What does membrane stripping/sweeping do? When is it done? Benefit?
Stimulates prostaglandin release by sweeping in between bag or waters and cervix
Done at 41 weeks decreases risk of going past 42 weeks
Lower risk of needing other IOL methods
What are the risks/disadvantages to membrane stripping/sweeping?
Pain/discomfort/contractions
Inadvertent ROM
Bleeding
What are evidence based natural methods that may cause cervical ripening?
Acupuncture
Shiatsu acupressure
Breast stimulation
Castor oil (laxitate-NV)
Date fruit
Evening primrose oil (EPO)
What are natural methods that have no evidence behind causing cervical ripening?
Pineapple
Sex
Red raspberry leaf tea (increases risk of hemorrhage if used a lot)
What are the benefits of cytotec?
Effective cervical ripening agent
May cause onset of labor
What are the risks of cytotec?
Tachysystole
Uterine rupture (high risk after c-sec, uterine scar)
Fetal bradycardia
Amniotic fluid embolism very rare-death
How long should you monitor after initial dose of cytotec? How often after that? What are you watching for?
Monitor for at least an hour after giving the dose and then at least every 30 minutes watching for tachysystole and FHR decelerations
Tachysystole –> late decels or prolonged decels because no enough time to recover
What is Pitocin used for?
Medical stimulation of uterine contractions
Induction or augmentation
What are the requirements for Pitocin use? Dose?
Need main line IV with LR or NS
Secondary on a pump
Closest port to pt b/c do not want to bolus, want to mix
T-1/2 of oxytocin is ~ 5 min
Multiple methods of mixing 10 U Pitocin w/ IV fluids
Low dose: begin at 1-2 mIU/minute
Increase by 1-2 q 30 min based on CTX pattern
What are the risks of using Pitocin?
Uterine tachysystole
Uterine rupture (Rare)
Water intoxication (Rare)