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NURS 330: Obstetrics > LEC 6: Induction and Augmentation of Labour > Flashcards

LEC 6: Induction and Augmentation of Labour Flashcards

1
Q

Induction

A

The initiation of contractions in the pregnant woman not in labour

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2
Q

Augmentation

A

Enhancement of contractions in the pregnant woman already in labour

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3
Q

Cervical Ripening

A

Use of pharmacological 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

Indications of Labour

A
  • Postterm pregnancy
  • Hypertensice disorders (pre-eclampsia)
  • Diabetes mellitus
  • Significant maternal disease not responding to treatment
  • Significant, but stable antepartum bleeding
  • Chorioamnionitis
  • Post-dates pregnancy of 41 or more weeks gestation (confirmed dates)
  • Rh Isoimmunization at/or near term
  • IUGR
  • PROM at or nreat term (especially if GBS positive)
  • Intrauterine fetal death
  • Logistical concerns
  • Intrauterine death in previous pregnancy
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5
Q

Indications to Induce Labour: Postmaturity

A
  • SOGC recommends that women should be offered induction between 41 and 42 weeks because there is a decrease in prenatal mortality without an inccreased risk of C-section. If women wait beyond that- mindful of fetal well being- doing a non-stress test, amniotic fluid testing.
  • Risk for inducing someone who has had 5 babies
    • The labour can end u being fast
    • Risky for mom and baby
  • Cautions if thecervix has not dropped
  • Known malpresentation- brow or face- more difficult delivery about induction as well- uterus overly distended has trouble with contractions, less effecctive
  • Existing care- extremely cautious because at risk of uterine rupture
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6
Q

What does postmaturity mean?

A
  • Post date or post term
  • Certainty about dates
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7
Q

What are the risk of psot-term?

A
  • Maternal
  • Fetal
    • Fluid can drop increased the risk of cord prolapse
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8
Q

Cautions for Induction

A
  • Grand multiparity
    • G5
  • Vertex not fixed in the pelvis
  • Unfavourable or unripe cervix
  • Brow or face presentation
  • Over distention of uterus (polyhydramnios or multiples)
  • Lower segment uterine scar (extreme caution)
  • Pre-existing hypertonus
  • Prior hisotry of difficult labour and/or traumatic delivery
  • Availability of C-section delivery
  • Any contradiction ot labour or vaginal delivery
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9
Q

Contraindications to Induction

A
  • Placental
    • Complete placenta previa
  • Cord
    • Presentation or proplapse
  • Fetal malpresentation (transverse lie, breech)
  • History
    • Previous uterine surgery or classical c/s
    • Pelvic abnormalities/ absolute CPD (cefal pelvic dispeprotion)
    • Gyne/ Obs/ Medical condition
  • Not going to induce for convenience- hsa to be a reason
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10
Q

Bishop Score

A
  • Score cervial ripening (pre-induction)
  • A cervix that is soft and effaces is the most important contributor to the success of induction
    • Unvavourable is a socre of <6
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11
Q
A
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12
Q

Methods to Induction

A
  • Nipple Stimulation
    • Initiate the hormones
  • Sexual intercourse
    • Initiate the hormones
  • Acupuncture
  • Enema, castor oil
  • Herbal supplements
  • Also….stripping/sweeping, amniotomy, mechanical, pharmacological
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13
Q
A
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14
Q

Stripping/ Sweeping Membranes

A
  • Mechanical separation of membranes from cervix or uterus
  • Does not require monitoring or other assessments
  • Do not use for induction when there are high priority indications
  • Effectivness
    • Does not always work
    • Going between the embryotic mebrane and the cervix; sometimes its done with a plan and sometimes its not done with a plan
    • If it works- go into labour in 48 hours
    • Will end up getting crampy- if they do it- usually between 31 and 38 weeks
    • Gloved finger- rotates 360 degress all the way around
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15
Q

What are the risk of stripping/ Sweeping membranes?

A
  • Cause bleeding
  • Inadvertent rupture of membranes
  • Puts persone at risk for infection
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16
Q

Amniotomy: AROM

A
  • Augment or induce labour
  • Committed to delivery because created a portal for risk of infection
  • Apply internal fetal or contraction monitors
  • Obtain fetal scalp blood sample for pH monitoring
  • Will rupture the membranes when they give oxytocin
  • If ruptured- need to monitor the fetus both during and after the procedure
  • Cord prolapse is a risk
  • Document the time the membrane ruptured- look at colour and composition of membrane
17
Q
A
18
Q

Mechanical Dilation

A
  • Cervical ripening ballon (CRB)
  • Laminaria (Seaweed)
    • Sterilized seaweed that is highly absorbent
  • Foley
19
Q

Pharmacological Cervical Ripening

A
  • Prostaglandin Induction
    • Prostin (Prostaglandin E2 1-2 mg. gel) into posterior fornix of vagina​
      • Produced naturally in the body- but would be artificial
    • Cervidil (Prostaglandin E2 10 mg. vaginal insert) into posterior fornix - continuous slow release
    • Like a tampon that gets inserted BUT is slow release
    • Benefit: If you end up hyper stimulating you can remove- if you use gel cannot remove
    • Promote effacement and softening of the cervixe = ripening of the cervix
    • Might speed up the labour BUT may hyper stimulate the delivery
    • Many people chose this option because its more of a natural way to starting labour
  • Misoprostol/Cytotec (Prostaglandin E1 synthetic-tablet) 50mcg orally or 25mcg vaginally - approved for induction in Canada in 2013
    • Has other uses such as helping terminate a pregnancy, help with hemorrhage
20
Q

Advantafes of Prostaglandin

A
  • Less invasive, more physiologically like labour
  • Simple administration, increase acceptance
  • Cervidil
    • May be able to go home post isertion
  • Generally used for induction, not augmentation
  • Nursing care per unit policy (includes fetral assessment; VS; teaching)
21
Q
A
22
Q

Pharmacological: Uterotonic

A
  • Oxytocin Infusion
    • ​Syntocinon/ Pitocin
    • Used fro both induction and augmentation
    • Half-life is aroun 7 to 12 minutes
    • Given IV via pump as secondary line
      • Want it clost to patient- do not want a bunch of oxytocin in the line incacse hyper-stimlation occurs- want to attach it as close as possible to the patient
    • Protocol requires gradual increase >30 minute incremetns
    • Patient needs to signs a consent from if used fro induction; don’t need a consent if used fro augmentation
23
Q
A
24
Q

Nursing Care with Oxxytocin Induction

A
  • Continuous ovservation by an RN as per facility protocol
  • Assess contractions and FHR q15 minutes
  • Maternal vital signs q15-30 minutes
  • Fetal Surveillance
    • ​When a normal tracing is identified, it may be appropriate to interrupt the EFM tracing for up to 30 minutes to facilitate ambulation, bathing, position changes providing the maternal – fetal condition is stable and infusion rate has not been increased
25
Q

During Labour

A
  • Hyperstimulation
    • Excessive uterine activity often with atypical or abnormal FHR tracing
  • Tachysystole
    • >5 contractions in 10 minutes
  • Hypertonus
    • Abnormally high resting tone (uterus that wont relax)
  • Tetanic
    • Contraction lasting more than 120 seconds
  • Any of these things will decrease perfusion to the fetus
  • Important to assess resting tone and FHR
26
Q

Hyperstimulation Can Result in:

A
  • Abruption of placenta
  • Hypoxia to fetus
  • Preciptious delivery
  • PP uterine atony
27
Q

What do you do if hyperstimulation occurs?

A
  • Reduce contraction/ reduce uterine stimulation
    • Stop oxytocin
    • Take out prosteglandin
    • Wip our the prostin gel
  • Open IV
  • O2 per mask
  • Continue to monitor
  • Administer ordered tocolytic
  • Provide support and reassurance
  • Can use a tocalytic if the fetus is being compromised (Nitrogen)
28
Q

After Delivery

A
  • Risk of postpartum hemorrhage/ PP atony is increased with induction (monitor)
    • More at risk because if the uterus was not doing it them- ot is not doing it now
  • Watch for signs of PPH
  • Consider continued infusion of oxytocin titrated to findus/ flow
29
Q

Augmentation

A
  • Interventions include rupture of membranes (amniotomy) and pharmacological (oxytocin only)
  • Nursing measures as per induction
  • Note:
    • These interventions increase the likelihood of vaginal delivery when done for active labour dystocia
    • These interventions increase the likehood of Cesarean section when done for slow progress in latent labour
30
Q

Labour Dystocia

A

Non-progression in active labour

31
Q

What are the 6 care practices that support normal birth?

A
  1. Labor begins on its own
  2. Freedom of movement thoughout labour
  3. Continuous labour supprots
  4. No routine interventions
  5. Spontaneous pushing in upright or gravity-neutral positions
  6. No seperation of mother and baby, with unlimited opportunities for breastfeeding

NURS 330: Obstetrics (19 decks)

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