Induction of labor

Question 1

Tool designed to measure if induction of labor is appropriate

Answer 1

Bishops score

- higher the better

Question 2

Cervical ripening agent where you lay for 30 minutes and oxytocin can be used 6 hours later

How much do you use?

Antidote for prostaglandins ripening agents

Answer 2

Prepidil gel w syringe

But not used as much bc it can’t be removed very well if something goes wrong.

Terbutaline antidote

Question 3

Mechanical dilators

Answer 3

Foley catheter ballon inserted w 30-50 ml of saline.

• Works by triggering the release of endogenous prostaglandins
• can be uncomfortable but falls out 8 hours later or at 3 cm dilation

Question 4

Hydroscopic dilators

Answer 4

Absorbs fluid and causes swelling

• Laminara tents - natural seaweed
• Lamicel - magnesium sulfate contained

Can be uncomfrtable. Leave in place for 6 hrs

Question 5

Sweeping

Answer 5

An office procedure.

Question 6

Natural methods of induction

Answer 6

Coitus
Nipple stimulation
Walking or curb walking

Question 7

Alternative inductions method

Answer 7

blue cohosh
primrose oil
castor oil
acupuncture

Question 8

Why do you want pitocin to be closest to you and in the secondary line?

Answer 8

So you can stop it if need be and have it not affect other fluids

Question 9

Oxytocin/Pitocin induction

How is it done?

What should you as the nurse be monitoring for at this time?

Answer 9

Hormone released from posterior pituitary to stimulate contractions and milk ejection too

30 units of oxytocin added to 500 ml bag
1 milliunit/min
- given piggy back

Monitor the strip! And if you need to increase the pitocin, then you will decrease the mainline IV solution to keep it balanced.

Question 10

Why wouldn’t you want to give pitocin?

Answer 10

Client refusal
Abnormal placenta
Transverse fetal lie
Uterine classic scar
Genital herpes that is active
Umbilical cord 
Absolute CPD

Question 11

Pre-requisites for pitocin induction

Answer 11

Known LMP
Ultrasound 
Timing of quickening
L/S test or PG levels
Ripe cervix
Favorable fetal position cephalic

Question 12

When do you adjust pitocin

Answer 12

After you evaluate maternal and fetal response.
Stop once contractions are good
Or when max dose is up

Question 13

How soon will uterus respond to pitocin
Half life of pitocin

How soon should steady state of pitocin be established

Answer 13

5 min max
Half life is 10-12 min

within 40 minutes

Question 14

What if the dose of pitocin is above 20mu/min

Answer 14

ADH affect so monitor urinary output , BP, and HR hourly

Question 15

When do you DISCONTINUE the pitocin?

Answer 15

Discontinue:

Non-reassuring fetus

UC are more frequent than 5 contractions in 10 minutes averaged over a 30 min time frame
- tachysystole = too many

Duration exceeds 60 seconds

Resting tone is increasing

Question 16

Fetal resuscitation measures during labor

Answer 16

Bolus of plain fluids
Turn pt on side for variable decels
O2 face mask
Administer the tocolytic drug (antidote for pitocin too)
Give nitric oxid to vasodilate
Tell doctor

Question 17

How to calculate MVU

How to know if the mvu is enought to initiate labor?

Answer 17

Peak of the amplitude - baseline pressure when not in contractions
Do this for contraction within 10 minutes

• each stage of labor will have its own mvu

First stage only * if the contractions are more than 40 mmhg and the mvu’s are between 80-120 in first stage (since this is beginning of labor anyways)

Question 18

Cervical ripening agent where you lay for 2 hours. And oxytocin can be used 30 minutes later

How is it removed?

Answer 18

Cervidil

Can be removed by pulling on retrieval string. Can use oxytocin 30 min later. Small amount inserted.

Question 19

Cervical ripening agent where you lay for 2 hours but then can only use oxytocin 4 hours later

Answer 19

Cytotec in a misotropl tablet

Used mostly for PPH in rectal route.