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OB/Community Health > Induction of Labor > Flashcards

Induction of Labor Flashcards

1
Q

What is an induction of labor ?

A

chemical or mechanical initiation of uterine contractions before their spontaneous onset (not in active labor)
- medically induced vs. elective
- BISHOP score
- 39 wks or greater
- risks must be weighted against the benefits to the woman and fetus

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2
Q

What are some maternal medical indications for induction of labor (IOL) ?

A
  • hypertensive disorders of pregnancy (HDP)
  • intrauterine fetal demise (IUFD): baby died while in uterus, can cause infection
  • Chorioamnionitis: infection of amniotic fluid
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3
Q

What are some fetal medical indications for induction of labor (IOL) ?

A

any situation where risks to the fetus significantly outweigh the benefits of continuing the pregnancy
- diabetes (can affect functioning of the placenta and lead to calcification)
- postterm pregnancy, especially with oligohydramniosis
- hypertensive disorders of pregnancy (HDP)
- intrauterine growth restriction (IUGR)
- isoimmunization
- chorioamnionitis (infection)
- premature rupture of membranes (PROM) with established maturity

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4
Q

What is a elective induction ?

A

induction without a medical indication
- ACOG states elective induction should not occur prior to 39 weeks of gestation

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5
Q

What are some reasons to have a elective induction ?

A
  • convenience: pt or provider
  • partner availability: like partner is in the army
  • help with kids at home
  • maternal fears/anxieties
  • maternal discomfort
  • insurance reasons
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6
Q

What are some contraindications for induction of labor (IOL) ?

A
  • Acute, severe fetal distress: nonreassuring fetal pattern, adding meds to induce labor can only make it worse
  • shoulder presentation (transverse lie)
  • floating fetal presenting part
  • uncontrolled hemorrhage
  • placenta previa: placenta covers the cervical opening: inducing contractions will put pressure on the placenta and hurt blood vessels
  • previous uterine incision
  • Actie genital HSV
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7
Q

What is augmentation of labor ?

A

the stimulation of uterine contractions after labor has started spontaneously and progress is unsatisfactory
- hypotonic uterine dysfunction leads to slowing of the labor process

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8
Q

What are some methods to induce labor ?

A
  • Chemical: cervical ripening agents & oxytocin
  • mechanical dilators: cervical ripening balloon (CRB)
  • membrane
  • stripping/sweeping
  • amniotomy (AROM)
  • physical: intercourse, nipple stimulation, walking
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9
Q

What are some methods of augmentation ?

A
  • Chemical: oxytocin
  • amniotomy
  • Noninvasive: emptying the bladder, walking, position changes, relaxation, hydration, hydrotherapy
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10
Q

What is a BISHOP score ?

A

rating system used to evaluate inducibility and cervical readiness/ripeness
- 13 point scale to calculate total score and document prior to use of cervical ripening or induction agents
- a score of 8 or more indicates the likelihood of vaginal birth is similar where labor is spontaneous or induced
- score below of 8 means a cervix won’t open up or soften enough to dilate

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11
Q

What is the original cervical position ?

A

posterior and ends up in the anterior

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12
Q

What bishop score do you need to use Oxytocin ?

A

score of an 8 or above

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13
Q

What needs to happen before you can give oxytocin for a bishop score under 8 ?

A

need a medication to ripen/soften the cervix
- then you can give oxytocin

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14
Q

What methods are there for cervical ripening ?

A
  • chemical agents: prostaglandins
  • mechanical and physical methods: Balloon catheter that fills up the inside of the cervix and another balloon on the outside of the cervix to apply pressure on both sides. This stimulates the body to naturally release oxytocin and help soften the cervix
  • alternative methods
  • amniotomy: take amni hook and provider breaks the membranes (amniotic sac)
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15
Q

What are the 2 medications that are Prostaglandins ?

A
  • cytotec
  • cervidil
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16
Q

What is function of Cytotec (Misoprostol) ?

A

an ulcer medication
- has an off-label use for cervical ripening/IOL
- ripens cervix making a softer and easier to dilate and effact
- stimulates uterine contractions

17
Q

What situations are Cytotec contraindicated against ?

A

VBAC (vaginal birth after c-section)
- given her a tablet (which can’t be removed from someone’s system) will create pressure and it can burst the previous uterine stitch and cause uterine rupture

18
Q

What does the dose look like for Cytotec ?

A
  • applied near the cervix
  • 25-50 mcg q4hrs or until effective contraction pattern established
19
Q

What are some side effects of Cytotec ?

A
  • N/V
  • diarrhea
  • fever
  • uterine tachysystole (greater then 5 contractions in 10 minutes)
20
Q

What are some RN considerations for Cytotec ?

A
  • Pitocin started no sooner then 4 hours after last dose given (can lead to uterine burst if given together and can cause uterine tachysystole)
  • explain procedure and S/E and verify informed consent obtained
  • maintain supine position with lateral tilt or side-lying for 30-40 mins after insertion (to ensure it doesn’t’ fall out)
  • assess maternal VS, FHR, and contraction pattern (baseline and ongoing)
21
Q

What is the function Cervidil (Dinoprostone) ?

A
  • ripens cervix making it softer and easier to dilate and efface
  • stimulates uterine contractions
  • given to ripen the cervix and induce labor
22
Q

What does the dose of Cervidil look like ?

A
  • applied near the cervix
  • 10 mg vaginal insert
  • gradual release of med
  • removed at 12 hrs or once in active labor (or if tachysystole/fetal distress occur)
23
Q

What are some side effects of Cervidil (Dinoprostone) ?

A
  • N/V
  • diarrhea
  • fever
  • hypotension
  • uterine tachysystole
24
Q

What are some RN considerations of Cervidil ?

A
  • Pitocin started no sooner than 30 minutes after insert removed (can be started 30 mins after removal)
  • explain procedure and S/E & verify informed consent obtained
  • maintain supine position with lateral tilt or side-lying for 2 hrs after vaginal insert placed (to keep in place)
  • assess maternal VS, FHR, and contraction pattern (baseline and ongoing)
25
Q

What are some RN considerations for Amniotomy (AROM) ?

A
  • verify no active genital HSV outbreak
  • explain procedure: amniotic bag is broken and then the baby’s head rests upon the cervix which causes pressure on the cervix and it creates pressure which naturally causes a release of oxytocin
  • note TACO (time, amount, color, odor)
    • Assess FHR to ensure fetal well-being
    • maternal temp every 2 hrs
26
Q

What is Oxytocin ?

A

hormone normally produced by the posterior pituitary gland
- stimulates uterine contractions
- used to induce labor or augment a labor progressing slowly because of inadequate uterine contractions

27
Q

What are some risks of Oxytocin use ?

A

High alert med
- placental abruption
- uterine rupture
- unnecessary c-section
- after birth hemorrhage
- infection
- fetal hypoxemia and acidemia
- piggyback with normal IV fluids

28
Q

What are some RN considerations for Oxytocin ?

A
  • know policy and procedures in case of intrauterine resuscitation
  • assess VS, FHR, and contraction patterns
  • watch for signs of bleeding, tachysystole, fetal distress, ROM
  • increase oxytocin per provider order and policy

OB/Community Health (12 decks)

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