OB Procedures

Question 1

What is the most common reasons that induction may occur?

Answer 1

Fetus is LGA

Question 2

Why should induction not occur if a fetus is LGA?

Answer 2

Ultrasound screenings to determine fetal size are oftentimes inaccurate

Question 3

What kind of drug is pitocin?

Answer 3

High alert

Question 4

What can happen if you give a patient too much pitocin?

Answer 4

abnormal acid base for fetus, labor dystocia (uterus failure)

Question 5

What is induction?

Answer 5

stimulation of contractions before spontaneous onset of labor, with or without ruptured membranes, for the purpose of accomplishing a vaginal birth

Question 6

What is augmentation?

Answer 6

stimulation of contractions when spontaneous contractions have begun but are not causing progressive dilation or descent

Question 7

What percentage of labors are induced?

Answer 7

around 27%

Question 8

What is considered an early term induction?

Answer 8

37-39 weeks gestation

Question 9

Who should not be getting an induction?

Answer 9

someone with placenta previa/vasa previa, pelvic abnormalities, prior vertical uterine incision, active genital herpes, HIV positive status, abnormal fetal position, or contraindications to spontaneous labor/vaginal birth

Question 10

What are medical indications for inductions?

Answer 10

post dates, pregnancy induced hypertension, premature or prolonged ROM, chorioamnionitis, IUGR, fetal demise, medical problems (diabetes, heart disease, renal disease)

Question 11

What is included in the Bishop score?

Answer 11

Dilation, effacement, fetal station, cervical consistency, cervical position

Question 12

What does a higher score on the Bishop scale indicate?

Answer 12

Easier induction of labor

Question 13

What are risks of labor induction?

Answer 13

Tachysystole (fetal distress), uterine rupture, water intoxication from oxytocin, cesarean delivery (if induction fails)

Question 14

What are 4 medical interventions to help induce labor?

Answer 14

use of synthetic prostaglandins, pitocin, AROM, stripping of the membranes

Question 15

What happens when membranes are stripped?

Answer 15

release of prostaglandins

Question 16

What does AROM do?

Answer 16

releases prostaglandins

Question 17

What are two synthetic prostaglandins that are often used to “ripen” the cervix?

Answer 17

misoprostol (cytotec) and dinoprostone (prepidil/cervidil)

Question 18

What are some holistic methods that can induce labor?

Answer 18

nipple stimulation, intercourse/orgasm, herbs, castor oil/enemas, acupuncture

Question 19

What is the difference between cervidil and prepidil?

Answer 19

cervidil is a vaginal insert controlled-release and prepidil is a gel placed vaginally Q6H

Question 20

What are some side effects of cervical ripening with prostaglandins?

Answer 20

tachysystole, Category II or III FHR, Diarrhea!!

Question 21

What are the typical concentrations of oxytocin?

Answer 21

10 units in 1000mL lactated ringers (6mL/hr) or 20 units in 1000mL lactated ringers (3mL/hr)

Question 22

How can oxytocin be administered?

Answer 22

IV or IM

Question 23

What is the goal for contractions in 10 minutes?

Answer 23

3 contractions lasting 40-60 seconds each

Question 24

What should be monitored in order to titrate the dose of pitocin given to the mother?

Answer 24

maternal and fetal response

Question 25

What is an amnioinfusion?

Answer 25

Infusion of sterile normal saline or Lactated Ringer’s solution warmed to body temperature through an intrauterine catheter into the uterine cavity

Question 26

What is the purpose of an episiotomy?

Answer 26

surgical incision of the perineal body to enlarge the outlet

Question 27

What is the definition of a vacuum assisted birth?

Answer 27

birth involving attachment of vacuum cup to fetal head and using negative pressure to assist in birth of the fetus

Question 28

What are indications for cesarean birth?

Answer 28

labor arrest, nonreassuring fetal tracing, malpresentation, multiple gestation, materal-fetal, macrosomia, other obstetric indications, preeclampsia, maternal request (in this order)