M3L2: Induction and Augmentation of Labor

Induction

Labor is started artificially

Augmentation

Assisting labor that has started spontaneously but is not effective

39

(Induction) Although induction may be necessary to initiate labor before the time when it would have occurred spontaneously because a fetus is in danger, it is not used as an elective procedure until the fetus is at term (over ___ weeks)

Longitudinal

(Induction: Conditions should be present) The fetus is in a ___ lie ; Presenting part is the fetal head (vertex)

Oxytocin

(Induction) A synthetic form of naturally occurring pituitary hormone ; Used to initiate uterine contractions in a term pregnancy (over 39 weeks)

Intravenously

(Induction: Oxytocin) Is always administered ___, so that, if uterine hyperstimulation should occur, it can be quickly discontinued

3

(Induction: Oxytocin) Because the half-life of oxytocin is approximately ___ minutes, the falling serum level and effects are apparent almost immediately after discontinuation of IV administration

60 ; 90

(Hyperstimulation) The danger of hyperstimulation is that a fetus needs ___ to ___ seconds between contractions in order to receive adequate oxygenation from placenta blood vessels.

Hyperstimulation

Five or more contractions in a 10-minute period or contractions lasting more than 2 minutes in duration or occurring within 60 seconds of each other, situations that have the potential to interfere with placenta filling and fetal oxygenation

Left ; IV Fluid Bolus

(Hyperstimulation)

• If it should occur

  • Ask the woman to turn onto her ___ side to improve blood flow to the uterus

  • Administer an ___ ___ ___ to dilute the level of oxytocin in the maternal bloodstream

8 ; 10 ; Terbutaline

(Hyperstimulation)

• If it should occur

  • Administer oxygen by mask at ___ to ___ L are all helpful

  • ___ to relax the uterus (as prescribed)

Oxytocin Infusion

(Hyperstimulation)

• If it should occur

  • The surest method to relieve tachysystole: immediately discontinue the ___ ___

Pitocin

(Administration of Oxytocin) Synthetic version of Oxytocin

10 ; 1000

(Administration of Oxytocin) Oxytocin: ___ IU(a.k.a. 1ml) in ___ ml of Ringer’s Lactate

15 ; 60

(Administration of Oxytocin)

Alternative dilution method

• ___ IU of oxytocin to ___ ml of IV solution

• This yields a concentration of 60 milliunits per 1 ml

1 - 2 ; 30 - 60

(Administration of Oxytocin)

Prescription for administration

• usually designates the number of milliunits to be administered per minute such as ___ - ___ milliunits per minute at ___-___ minute intervals until a contraction pattern similar to normal labor is achieved

• Don’t increase the rate by more than 2 milliunits at a time

30 ; 500

(Nursing Implications of Induction by Oxytocin) Obtain an oxytocin infusion solution from a pharmacy (___ units/___ ml fluid)

Hypotension

(Nursing Implications of Induction by Oxytocin) If ___ occurs, discontinue the drug and notify the primary care provider

Water Intoxication ; 150

(Nursing Implications of Induction by Oxytocin) Monitor intake and output and watch for signs of possible ___ ___, such as headache or vomiting. Limit IV fluids to ___ ml/hr

Hypotension

(Side effects of Induction by Oxytocin) Causes peripheral vessel dilation

Water intoxication

(Side effects of Induction by Oxytocin) Decreased urine flow

Augmentation by Oxytocin

May be used if labor contractions begin spontaneously but then become weak, irregular, or ineffective (i.e., hypotonic)