Class 6: Induction & Augmentation Labor

Question 1

what is induction of labor

Answer 1

• chemical or mechanical initiation of uterine contractions before their spontaneous onset for the purpose of bringing about the birth

Question 2

what is augmentation of labor

Answer 2

• the stimulation of uterine contractions after labor has started spontaneously but progress has been unsatisfactory

Question 3

what is elective induction of labor

Answer 3

• when the pregnant person wants to be induced
• not typically allowed

Question 4

what are risks of elective induction (3)

Answer 4

• increased incidence of c-section
• neonatal morbidity
• and costs

Question 5

what are indications for labor induction (14)

Answer 5

• pre-eclampsia >37 weeks
• signif antepartem hemorrhage (placental abruption, NOT previa)
• chorioamniotitis
• suspected fetal compromise (ex. poor BPP score, poor doptone analysis)
• term prelabor rupture of membranes with maternal GBS colonization
• postdates
• uncomplicated twin pregnancy >38 weeks pregnancy
• diabetes
• alloimmune disease
• IUGR
• oligohydramnios
• gestational HTN > 38 weeks gestation
• intrauterine fetal death
• PROM near or at term (GBS negative)

Question 6

if membranes rupture, will give pregnant person 24 h to go into labor unless… (2)

Answer 6

• GBS positive
• signs of infection

Question 7

what is a contraindication for induction

Answer 7

• placenta previa
• other factors that contradict general labor

Question 8

what is used to help us determine when to start an induction?

Answer 8

• bishop score

Question 9

what does the bishop score determine?

Answer 9

• when the cervix is favorable for induction –> identify cervical ripening (softening)

Question 10

what can be given to promote cervical ripening

Answer 10

• chemical agents (prostaglandins)
• mechanical and physical methods (balloon catheter)

Question 11

what are 2 prostaglandin gels that are inserted into the posterior part of the vagina

Answer 11

• prostin
• prepadol

Question 12

what is a postaglandin topical agent attached to a string that can be pulled out of the vagina if strong labor is accidentally induced

Answer 12

• cervadil

Question 13

prostaglandins can cause..

Answer 13

• induction, but rare

Question 14

what is required monitoring after admin of a cervical ripening agent

Answer 14

• continuous fetal monitoring for 1 hr

Question 15

describe use of a balloon catheter for cervical ripening

Answer 15

• balloon inserted into the uterus
• pokes the amniotic membranes which are closely laid against cervix
  = triggers release of prostaglandins
• keep inflated balloon in cervix for 24 h or will fall out on its own as cervix dilates

Question 16

when do we not admin prostaglandins for cervical ripening? why?

Answer 16

• in someone has PROM –> prostaglandins already present

Question 17

what is amniotomy

Answer 17

• artifical rupture of membranes

Question 18

amniotomy may be done to…

Answer 18

• augment labor in combo w oxytocin

Question 19

describe nursing care/assessments w amniotomy (5)

Answer 19

• hygiene (changing of pads, etc.)
• FHR (concern of prolapse)
• assess temp q2h
• assess for S&S of infection
• assess characteristics of amniotic fluid

Question 20

the mother should be.. (2) for an amniotomy to occur

Answer 20

• HIV negative
• no active herpes

Question 21

what is oxytocin

Answer 21

• hormone normally produced by posterior pituitary gland
• stimulates uterine contractions

Question 22

oxytocin is used to…

Answer 22

• induce labor or augment a labor progressing slowly bc of inadequate uterine contractions
• used following birth to control postpartum bleeding

Question 23

what is the goal of using oxytocin for augmentation/induction of labor

Answer 23

• want adequate contractions @ lowest possible dose –> start low and slow

Question 24

what is the concern w admin of oxytocin

Answer 24

• tachysystole

Question 25

what are indications for oxytocin (9)

Answer 25

- suspected fetal jeopardy - inadequate uterine contractions, dystocia - prelabor rupture of membranes - post-term pregnancy - chorioamnionitis - maternal medical conditions - gestational HTN - fetal death - augmentation of labor

Question 26

what are contraindications for oxytocin (9)

Answer 26

- cephalopelvic disproportion - prolapsed cord - transverse lie - abnormal FHR (can make worse) - placenta previa or vasa previa - prior classic uterine incision or other uterine surgery (worried abt incision line) - active genital herpes infection - invasive cancer of cervix - previous uterine rupture

Question 27

what type of monitoring should be done w use of oxytocin

Answer 27

- EFM

Question 28

in addition to tachysystole, what is there a risk of w use of oxytocin

Answer 28

- postpartum hemorrhage --> d/t uterus getting tired = can't contract as well

Question 29

what is augmentation of labor

Answer 29

- stimulation of uterine contractions after labor has started spontaneously but progress is unsatisfactory

Question 30

augmentation of labor is implemented for mngmt of...

Answer 30

- hypotonic uterine dysfunction

Question 31

what are common augmentation methods (2)

Answer 31

- oxytocin infusion - amniotomy *no prostaglandins, already have from ROM*