Week 2 Augmentation of labor Flashcards
Describe the pathway of fetal prostaglandin and placental oxytocin
- Cortisol from the mother stimulates the fetal hypothalamus
- The fetal hypothalamus releases CRH
- The CRH stimulates the release of cortisol form the adrenal glands
- Cortisol causes the release of Prostaglandins and placental oxytocin
What is induction?
Induction is the artificial starting of labor
What is augmentation?
When the mother is already having active contractions and needs a bit more help
Inductions are associated with higher risks of ____
C-sections
The risk of a csection during induction is reduced if ____
The cervix is dilated at least 2cm and somewhat effaced
What are some indications for induction?
When it is deamed medically necessary
- Hostile interuterine environment
- SROM at term without labor
- Post-term pregnancy
- Chorioaminonitis (infection and inflammation of amniotic sac
- HTN
- Placental abruption
- Medical conditions (DM, renal disease, heart disease)
- Fetal demise
Why is HTN an indication of induction?
Because it causes vasoconstriction and will restrict blood flow to fetus
What are the two largest risks involved with elective inductions?
- 2X risk of needing Csection
- Risk of Neonatal respiratory complications
Calculating an accurate _____ is critical if an elective induction is to be done
Gestational age
Current recommendations suggest waiting until ___ weeks to induce labor electively
40-41
When is augmentation considered?
When labor has begun spontaneously but progress is slow or stopped. Even if contractions are adequate
What is used to augment labor?
Oxytocin
What are some contraindications of induction or augmentation?
- Placenta Previa
- Vasa Previa
- Umbilical cord prolapse
- active gen. herp.
- Abnormal presentations
- Previous uterine surgery
- overdistention of uterus
- Severe maternal diseases
- fetal presentation above pelvic inlet
- inability to monitor fetal status
What is the function of pitocin?
It is oxytocin and it acts to strengthen contractions
What is Placenta Previa?
The placenta is over the birth canal
What are some of the major risks of inducing or augmenting labor?
- Excessive uterine activity
- Uterine rupture
- Maternal water intoxication
- Chorioamnionitis
- PPH
Why does using oxytocin increase the risk of maternal water intoxication?
-The solution used to dilute it is hypotonic
Prior to labor agumentation or induction, a ___ assessment must be done
Cervical
______ system is used to estimate cervical readiness for labor
Bishop scoring
What 5 aspects does the bishop score look at?
- Cervical dilation
- Effacement
- Consistency
- Position
- Fetal station
Vaginal birth is more likley with a bishop score of ____ or higher
8
What is cervical ripening?
- Softening the cervix to make it more likely to dilate during labor,
- It is done before induction
Cervical ripening is recommended with a bishop score of ___ or less
4
What is used to pharmacologically induce labor?
Prostaglandin PGE2
What is the drug name for Prostaglandin PGE2?
Misoprostol (Cytotec)
How is Misoprostol (Cytotec) administered?
-Vaginally
With higher doses of Misoprostol (Cytotec), there is a risk for ____
Uterine tachysystole
If Uterine tachysystole after administering Misoprostol (Cytotec) what are the interventions?
- Side-lying position
- O2 non-rebreather 10L
- give a tocolytic
After administering Misoprostol, the patient should remain _____ for ____
Recumbent for 30 minutes
Misoprostol (Cytotec) is contraindicated in women with ___
previous cesarean or other uterine surgery
What are the three mechanical methods to induce labor?
- Transcervical balloon catheter
- Membrane stripping
- Placement of hydroscopic inserts
Spontaneous labor from membrane stripping can occur _____
within 48 hours
____ needs to be assess prior to and throughout administration of Oxytocin
- Uterine activity
- FHR
Where should Oxytocin be infused?
Closest to the IV insertion site
_____ become desensitized with prolong use of Oxytocin
Oxytocin receptor sites
Why does the rate of oxytocin need to be reduced after active labor begins?
to decrease the receptor site saturation
What is the MOA of pitocin?
Stimulates uterine smooth muscle – strength, duration, and frequency of UC
Oxytocin has ____ and ____ properties.
This increases the risk of ___
Vasoactive and Antidiuretic
-Water intoxication
Why does uterine sensitivity to oxytocin increase during gestation?
Because of increasing prostiglandins
Pitocin is a ____ medication and requires ____
High alert
-Duel verification
What is the common low does of pitocin?
what rate is it increased?
- 5 to 2 miliunits/min
- Increase dose in 1 to 2 milliunits/min increment every 15 to 40 minutes
Pitocin is given after birth as well. Why?
-To prevent PPH via contractions in the uterus
The rate of pitocin for controling PPH is
20-40 milliunits/min
10-40 units is diluted into 1000ml of solution
If there is no iv acess, ____ units of pitocin is given via ___
10 units
IM injection
What is the rate of absorption of pitocin for IV
1 minute
What is the rate of absorption of pitocin for IM
3-5 minutes
How is pitocin excreted?
Renal
What is considered a “good” freq. of contractions?
every 2-3 minutes lasting 40-90 seconds
Do not induce labor if the child is not in ___ presentation
Cephallic
What needs to be assessed prior to inducing labor?
- presentation
- FHR
- UA
- VS
- intake and output
What is considered a elevated resting tone?
firm with palpation or >20 to 25 mm HG if measured with intrauterine pressure catheter
Montevideo units over ___ are considered bad
300-400
What is considered a normal fundus height postpartum?
At or 1 finger height above umbilicus
What three aspects of the fundus are assessed postpartum?
- Firmness
- Height
- Deviation
If the uterus is deviated after birth. It could mean that ____
The bladder is full
If the uterus is boggy after birth, what should be done?
Massage until firm
How can prolonged use of pitocin affect the post partum uterus?(induced/augmented labor)
It can causes fatigue of the uterine muscle. This leads to poor contraction strength r/t saturated oxytocin receptors and a risk for PPH
When observing postpartum lochia, what three things should be assessed?
Color, quantity, presence of clots
How often are post partum VS taken?(induced/augmented labor)
q15
We monitor post partum breath sounds. WHy?(induced/augmented labor)
To rule out water toxicity and pulm edema
What two postpartum assessment findings would be an automatic call to the provider?
- Uterus fails to remain contracted
- Bright red or clots in lochia
