OB exam 2 - Artificial Mgt of Labor Flashcards
advantages to labor induction
labor usually occurs in 24-48 hours
disadvantages to labor induction
-contractions may be less gradual
-dysfunctional uterine contractions
-increased bloody discharge
what needs to be down before induction of labor
-review pt, VS & obtain consent
-obtain reactive NST
-vaginal exam
-bishop score (the higher the score, the higher chance of a regular vaginal delivery)
amniotomy (AROM) nursing interventions
-check fetal HR
-note date & time
-note fluid (COAT)
check temp every 2 hours
what is a mechanically induction
cervical ripening
uses a foley bulb which puts pressure on the cervix just like the fetal head would causing prostaglandins to be released to soften the cervix
advantages of cervical ripening
-cervical effacement
-shorter labor
-lower requirements for oxytocin
-vaginal birth is achieved within 24 hrs for most women
-incidence of C section birth is reduced
risks of cervical ripening
-uterine hyperstimulation (for than 5 contractions in 10 mins)
-non reassuring fetal status
-higher incidence of PP hemorrhage
-uterine rupture
what meds can be given to induce labor
misoprostol & dineprostone (prostaglandins)
given vaginally to stimulate contractions to thin cervix & oxytocin
Cytotec
-dose is 25 mcg every 6 hours
-do not start pitocin induction within 4 hrs of last dose
cervidil
-dose 10mg vaginal insert over 12 hours
-bedrest 2 hours after dose then may be up to bathroom (pat dry after voiding)
-to remove, pull string
stripping of the membranes
-non pharm possible induction of labor
-separates the amniotic membranes from the lower uterine segment (can be uncomfortable & my see vaginal bleeding after)
-releases prostaglandins that stimulate contractions
only preformed by OB, nurse midwife or NP
what are the uses of Pitocin (Oxytocin)
induction or augmentation (help labor along)
risks of pitocin
-tachysystole contractions
-uterine rupture
-water intoxication (anti diuretic effect -> confusion, lethargic, vomiting and/or seizure)
-non reassuring fetal heart rate patterns
what do you do if pt experiences water intoxication from pitocin induction
stop pitocin -> give 9% normal saline & give furosemide
what needs to be done before administering pitocin
-need reactive NST
-vaginal score w/ bishop score
-check for foley bulb (can still use if in place)
-continuous fetal monitoring
how is pitocin titrated
increase 1-2 mu/min every 30 mins
what is a major risk if on pitocin for over 7 hours
post partum hemorrhage
what happens if you give pitocin as a bolus
will cause continuous hard contractions and baby will not get perfused well or good oxygen caused a prolonged decel
when does labor augmentation usually occur
during naturally occurring labors w/ hypotonic contractions
what are the main ways of performing labor augmentation
-pitocin
-AROM
amnioinfusion
warmed sterile NS or LR is placed into the uterus via IUPC
reasons for an amnioinfusion
-replacement of lost or absent amniotic fluid
-repetitive variable decelerations w/ increasing intensity
-meconium dilution
what should be occurring when an amnioinfusion is happening
water should be leaking back out
if no fluid noted and you have increased uterine resting tone, stop transfusion immediately
what intervention is done to encourage water to come out after amnioinfusion is turned off because of no fluid return
try to move baby’s head bc it could be acting as a stopper or change maternal position