Module 10 (Exam 3) Obstetric Procedures Objectives 1

Question 1

Cervical Ripening

Answer 1

Administration of prostaglandins to assist with cervical effacement

Question 2

Labor Induction

Answer 2

Initiation of labor prior to spontatenous onset

Question 3

Amniotomy

Answer 3

Artificial rupture of membranes (AROM)

Question 4

Oligohydramnios

Answer 4

Decreased (insufficient) amniotic fluid

Question 5

Polyhydramnios (Hydramnios)

Answer 5

Excessive amniotic fluid volume

Question 6

Oxytocin (Pitocin)

Answer 6

Induction or augmentation of labor at or near term. Maintence of firm uterine contractions after bith to control postpartum bleeding. Management of inevitable or incomplete abortion.

Contraindications: placenta previa, vasa previa, nonreassuring fetal heart rate patterns, abnormal fetal presentation, prolapsed umbilical cord, presenting part above the pelvic inlet, previous classic of other fundal uterine incision, active genital herpes infection, pelvic structural deformities, invasive cervical carcinoma

Adverse Reactions: tachysystole, impaired uterine blood flow, uterine rupture, abruptio placentae, trauma, maternal fluid retention, water intoxication, hypotension, tachycardia, cardiac dysrhythmias, hemorrhage. Fetal: bradycardia, tachycardia, fetal heart rate variability, and late decelerations, asphyxia may occur with diminished uterine blood flow, trauma

Question 7

Dinoprostone (Cervidil, Prepidil)

Answer 7

• Prepidil: prostaglandin gel. 0.5mg applied to cervix, may be repeated 6-12 hours later. max dose is 1.5 applied to cervix in a 24 hours period. 2.5mg vaginally
  
  • Hypotonic contractions with or without NRFHT: place in side lying position, provide oxygen by face mask at 8-10L/min, tocolytic drug such as terbutaline or mag sulfate. typically begins 1 hour after gel application. higher incidence with vaginal application
  • Oxytocin induction may begin: safe interval has not been established, delaying ocytocin administration for 6-12 hours after total intracervical dose of 1.5mg or 2.5 mg vaginal dose
  • Women should remain recumbent with lateral uterine displacement for 15-30 minutes after application
  • Increased effect if combined with other oxytocics
  • Increases hypertensive effect of herb ephedra
• Cervidil: 10mg in a time-release vaginal insert left in place for up to 12 hours
  
  • Remove with onset of active labor, membrane rupture or uterine hyperstimulation
  • Hypertonnic Contractions with or without NRHRT: may occur 9.5 hours after insert placement. Greater incidence than with lower-dose intracervical dinoprostone gel, remove insert
  • When oxytocin induction may begin: 30-60 minutes after removal of insert
  • Remove after 12 hours or when active labor begins
  • Adverse effects can be reduced within 15 minutes of removal
  • Most expensive option

Question 8

Misoprostol (Cytotec)

Answer 8

• One quarter of 100mcg tablet vaginally. Used for labor induction by repeating 25mcg dose every 3-6 hours. A 50mcg dose is associate with hypertonic contractions
• Hypertonic Contractions with or without NRFHT: Same as for dinoprostone gel. Higher dose or more frequent administration is more likely to cause excessive contractions, which may or may not be accompanied by a nonreassuring fetal heart rate pattern
• When oxytocin induction may begin: at least 4 hours after last dose
• 100mcg tablet is not scored. hospital pharamcy should prepare the 25mcg dose for greater accuracy.
• contraindicated in woman with a previous c section or other uterine surgery