OB Procedures Flashcards
What is the most common reasons that induction may occur?
Fetus is LGA
Why should induction not occur if a fetus is LGA?
Ultrasound screenings to determine fetal size are oftentimes inaccurate
What kind of drug is pitocin?
High alert
What can happen if you give a patient too much pitocin?
abnormal acid base for fetus, labor dystocia (uterus failure)
What is induction?
stimulation of contractions before spontaneous onset of labor, with or without ruptured membranes, for the purpose of accomplishing a vaginal birth
What is augmentation?
stimulation of contractions when spontaneous contractions have begun but are not causing progressive dilation or descent
What percentage of labors are induced?
around 27%
What is considered an early term induction?
37-39 weeks gestation
Who should not be getting an induction?
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
What are medical indications for inductions?
post dates, pregnancy induced hypertension, premature or prolonged ROM, chorioamnionitis, IUGR, fetal demise, medical problems (diabetes, heart disease, renal disease)
What is included in the Bishop score?
Dilation, effacement, fetal station, cervical consistency, cervical position
What does a higher score on the Bishop scale indicate?
Easier induction of labor
What are risks of labor induction?
Tachysystole (fetal distress), uterine rupture, water intoxication from oxytocin, cesarean delivery (if induction fails)
What are 4 medical interventions to help induce labor?
use of synthetic prostaglandins, pitocin, AROM, stripping of the membranes
What happens when membranes are stripped?
release of prostaglandins
What does AROM do?
releases prostaglandins
What are two synthetic prostaglandins that are often used to “ripen” the cervix?
misoprostol (cytotec) and dinoprostone (prepidil/cervidil)
What are some holistic methods that can induce labor?
nipple stimulation, intercourse/orgasm, herbs, castor oil/enemas, acupuncture
What is the difference between cervidil and prepidil?
cervidil is a vaginal insert controlled-release and prepidil is a gel placed vaginally Q6H
What are some side effects of cervical ripening with prostaglandins?
tachysystole, Category II or III FHR, Diarrhea!!
What are the typical concentrations of oxytocin?
10 units in 1000mL lactated ringers (6mL/hr) or 20 units in 1000mL lactated ringers (3mL/hr)
How can oxytocin be administered?
IV or IM
What is the goal for contractions in 10 minutes?
3 contractions lasting 40-60 seconds each
What should be monitored in order to titrate the dose of pitocin given to the mother?
maternal and fetal response
What is an amnioinfusion?
Infusion of sterile normal saline or Lactated Ringer’s solution warmed to body temperature through an intrauterine catheter into the uterine cavity
What is the purpose of an episiotomy?
surgical incision of the perineal body to enlarge the outlet
What is the definition of a vacuum assisted birth?
birth involving attachment of vacuum cup to fetal head and using negative pressure to assist in birth of the fetus
What are indications for cesarean birth?
labor arrest, nonreassuring fetal tracing, malpresentation, multiple gestation, materal-fetal, macrosomia, other obstetric indications, preeclampsia, maternal request (in this order)
