Induction and Augmentation of Labor

The deliberate initiation of labor before it occurs spontaneously.

labor induction

Refers to stimulation of effective uterine contractions when spontaneous contractions are inadequate

labor augmentation

This criteria is used to assess the readiness of the cervix for birth and induction. A total score of 8 and higher means the cervix is ready.

cervical bishop score

Early declarations of fetal heart rate is due to what?

fetal compression

Late decelerations of fetal heart rate is due to what?

uteroplacental insufficiency

Prerequisites for labor induction

• No CPD exist

• Fetus is mature or pregnancy is at or near term (over 39wks)

• Cervix is ripe soft and dilatable, w/ some degree of cervical dilatation & effacement

• Fetus is in longitudinal lie, presenting part is fetal head (vertex) & is engaged

Indication of labor induction

• Complication of pregnancy: PIH, placenta previa, abruption placenta, DM, renal disease, Rh incompatibility

• PROM

• Placental insufficiency

• Intrauterine growth retardation

• Intrauterine fetal death

Methods to promote cervical ripening

• stripping or sweeping the membranes

• hygroscopic suppositories

• insertion of a prostaglandin

Complications of “stripping the membrane”

• bleeding from undetected low-lying placenta

• inadvertent rupture of membranes

• possibility of infection if membranes should rupture

This method of labor induction is the artificial rupturing of membranes using amniotomy forceps such as amnihook or allis forceps

amniotomy

• This method of labor induction is when artificial Oxytocin is administered to the woman to stimulate uterine contractions.

• Rate of oxytocin is increased gradually until desired uterine contractions are achieved, w/c is about 3 to 4 contractions every 10 minutes

oxytocin stimulation

This method of labor induction is when hydroscopic dilators inserted a night before labor induction to cause cervical softening & dilatation when cervix is not ripe yet

laminaria tents or prostaglandins E2

These are suppositories of seaweed that swell on contact with cervical secretions that gradually and gently urge dilatations (laminaria technique)

hygroscopic suppositories

Hygroscopic suppositories can be held in place by gauze sponges with what?

• povidone-iodine

• antifungal cream

Some prostaglandins inserted into the posterior fornix of the vagina, by the cervix

• dinoprostone (prepidil, cervidil)

• misoprostol

This is a prostaglandin-impregnated plastic insert surrounded by mesh.

cervidil

What to monitor after insertion of prostaglandin?

• FHR

• SE: vomiting, fever, diarrhea, hypertension

What position should we place the patient after insertion of prostaglandin to prevent leakage or loss of the medication

side-lying

Oxytocin induction can be started after how many hours of prostaglandin dose

12 hours

Cervidil and Prepidil gel should be used with caution in patients with what due to hyperstimulation and danger of side effects?

• asthma

• renal or cardiovascular disease

• glaucoma

• past cesarean births

Interventions for hyperstimulation due to oxytocin

• turn patient to their left side to improve blood flow to the uterus

• administering IV fluid bolus to dilute the level of oxytocin

• administering oxygen by mask at 8 - 10 L

• terbutaline - relax the uterus

The surest method to relive tachysystole

immediately discontinue oxytocin infusion

SE of oxytocin

• peripheral vessel dilatation

• decreased urine flow (manifested by headache and vomiting; water intoxication can lead to seizures, coma and death)

Ways to asses for danger signs of oxytocin administration

• take patient’s blood pressure and pulse every hour

• monitor uterine contractions and FHR conscientiously

This is when a physician inserts a gloved finger into vagina to separate membranes from the lower uterine segment & to guide the allis or amniohook forceps.

amniotomy

Indications of amniotomy

• induce or augment labor

• perform internal fetal monitor

• determine color of amniotic fluid when fetal compromise is suspected

• prevent aspiration avoid of the contents of the amniotic sac at the moment of birth

Prerequisites of amniotomy

• Mother should be in active labor

• Mother should be at term

• Fetal head should be engaged

Complications of amniotomy

• prolapse of umbilical cord

• infection if delivery does not take place within 24 hours after BOW has ruptured

What should be done before an amniotomy?

put patient on NPO

During amniotomy, we should place the woman in what position?

lithotomy position

What should the physician check before removing his fingers from the vagina in an amniotomy procedure?

check for cord prolapse

What should the physician check before removing his fingers from the vagina in an amniotomy procedure?

check for cord prolapse

What should be immediately check after the rupture of the membranes during an amniotomy procedure?

check FHR

What should be noted after an amniotomy procedure?

• color and amount of amniotic fluid

• time of rupture (prolonged rupture may lead to infection)

Complications of oxytocin administration

• Uterine hypercontractility

• Fetal heart rate changes

• Respiratory distress in fetus especially when labor is induced before term

• More labor pain

• High parity is associated w/ increased incidence of precipitate labor, uterine rupture & postpartum hemorrhage.

Before oxytocin administration, what should be assessed first?

if patient has no CPD

Oxytocin administration should be avoided in what?

• Women w/ uterine scar – previous CS

• High parity – 6th or more pregnancy

• Overdistention – hydramnios

• Hypertonicity or uterus – 5 contractions in 10 minutes

• Abnormal presentation – breech, face

Monitor for what danger signs in oxytocin administration

• Uterine contractions lasting 70 seconds or longer

• Contractions occurring at less than 2 minutes interval

• Uterus not relaxing completely in between contractions

• Fetal accelerations and decelerations persists

• Urinary flow decreases to 30 mL/hr

• Signs of bleeding, placenta previa and abruption placenta occurs

Oxytocin should not be started for how many hours following administration of vaginal prostaglandins

6 hours

Maximum dose of oxytocin should not exceed how may milliunits/minute?

32 milliunits/minute