Labor Induction & Augmentation: Methods, Risks, and Monitoring

What is the purpose of labor induction?

To initiate contractions and begin labor artificially before it starts on its own.

What are some methods of labor induction?

Ambulation, nipple stimulation, prostaglandin administration, balloon catheter, and IV oxytocin.

What is augmentation of labor?

Helping an existing labor progress more effectively by strengthening or increasing the frequency of contractions.

What are some examples of labor augmentation methods?

Position changes, ambulation, AROM (Artificial Rupture of Membranes), and IV oxytocin.

What is Continuous Electronic Fetal Monitoring (EFM) used for?

It is recommended when labor is induced or augmented to monitor fetal well-being.

What is the Bishop Score?

A scoring system used to assess cervical readiness for labor induction based on dilation, effacement, consistency, position, and station.

What Bishop Score indicates a favorable cervix for induction?

A score greater than 8 indicates a favorable (ripe) cervix.

What are some medical indications for inducing labor?

Post dates >42 weeks, gestational hypertension, fetal distress, diabetes, preeclampsia, and intrauterine growth restriction (IUGR).

What are contraindications to induction?

Complete placenta previa, placental abruption, transverse fetal lie, prior classic uterine incision, and active genital herpes infection.

What is a significant risk associated with labor induction?

The main risk is that induction may be unsuccessful, leading to a need for cesarean section.

What are the potential risks for the mother during induction?

Postpartum hemorrhage (PPH), infection, increased risk for cesarean section, and longer hospital stays.

What are the potential risks for the baby during induction?

Abnormal fetal heart rate patterns, respiratory distress, and increased risk for NICU admission.

What are some natural methods for inducing labor?

Walking, sexual intercourse, breast/nipple stimulation, and hand expression.

What is the role of prostaglandins in labor induction?

Prostaglandins help ripen the cervix and stimulate uterine contractions.

What is Dinoprostone and how is it used?

Dinoprostone is a prostaglandin used for cervical ripening, available as a vaginal insert (Cervidil) or gel (Prepidil).

What is Misoprostol (Cytotec) and its administration routes?

Misoprostol can be given vaginally, orally, or sublingually and should not be given concurrently with oxytocin.

What is the significance of a non-stress test (NST) before induction?

It evaluates fetal heart rate response to movement to confirm the baby can handle the stress of contractions.

What does a 'reactive' NST indicate?

A reactive NST indicates that the baby's heart rate accelerates appropriately with movement, suggesting it is safe to proceed with induction.

What does an 'unfavorable' Bishop Score indicate?

A score of 6 or less indicates the cervix is not ripe, and cervical ripening methods may be needed before induction.

What is the impact of oxytocin overstimulation during induction?

Overstimulation can lead to tachysystole, which may cause fetal distress and other complications.

What are some logistical concerns that may necessitate labor induction?

Concerns such as maternal health risks or scheduling issues may lead to induction.

What are the signs of dystocia?

Dystocia is indicated by abnormal labor progression, which may require intervention.

What is the role of ultrasound before induction?

Ultrasound assesses fetal position, gestational age, and placental placement to ensure safe induction.

What is the purpose of cervical ripening before induction?

Cervical ripening prepares the cervix for labor, increasing the likelihood of successful induction.

What is the recommended action if a NST is non-reactive?

If a NST is non-reactive, induction may need to be postponed or further investigation is required.

What is the importance of monitoring fetal heart rate during induction?

Monitoring ensures the fetus can tolerate labor and helps identify any distress early.

What is the purpose of cervical ripening?

To soften, efface, and dilate the cervix to prepare for induction with pharmacological agents like oxytocin.

When is cervical ripening indicated?

Before starting oxytocin or if the Bishop score is ≤ 6 (unfavorable cervix).

What are the benefits of mechanical cervical ripening methods?

Low risk of uterine tachysystole compared to pharmacological methods and can be combined with pharmacologic agents later if needed.

What are some risks associated with mechanical cervical ripening?

Infection, bleeding, and accidental rupture of membranes.

What is the nursing role in cervical ripening?

Assess Bishop score, monitor fetal heart rate (FHR), contractions, and signs of infection, and provide comfort measures.

How does a Cervical Ripening Balloon (CRB) work?

A catheter with a small balloon is inserted through the cervix and inflated with saline, applying direct pressure to mechanically stretch the cervix.

What should patients be taught regarding CRB?

They can usually move, shower, and use the bathroom, but should notify the healthcare provider if contractions become regular, spontaneous rupture of membranes occurs, or signs of infection or bleeding appear.

What is Laminaria and how does it work?

Sterilized dried seaweed sticks inserted into the cervix that absorb fluid and swell, gently dilating the cervix over several hours.

What are key nursing points when using Laminaria?

Monitor for cramps, discomfort, and signs of infection.

What is membrane stripping (sweeping)?

The healthcare provider separates the amniotic sac from the uterine wall to stimulate natural prostaglandin release, ripening the cervix and sometimes starting contractions.

What are the indications for using Amniotomy (AROM)?

During active labor when the cervix is ≥ 6 cm dilated and contractions are present but not strong enough to cause continued dilation.

What are the risks associated with AROM?

Increased risk for infection, especially after 18 hours, and cannot be reversed once performed.

What is oxytocin and its purpose in labor?

Oxytocin (synthetic Pitocin) is a pharmacologic agent that stimulates uterine contractions and can be used for induction or augmentation of labor.

When is oxytocin used for induction?

When the cervix is ripe or favorable.

What are the risks of administering oxytocin?

Uterine tachysystole, hypotension, fetal distress, uterine rupture, and water intoxication.

What is tachysystole?

Too many or too-strong contractions leading to decreased oxygen to the baby, defined as more than 5 contractions in 10 minutes.

What are the features of tachysystole?

Resting period <30 seconds between contractions, contractions lasting >90 seconds, and abnormal FHR patterns.

How should tachysystole be managed?

Stop oxytocin, reposition the patient, administer ordered tocolytics, and provide continuous fetal monitoring.

What is the therapeutic goal when administering oxytocin?

Achieve stable contractions with 3-5 per 10 minutes, lasting 45-60 seconds, with normal FHR and good maternal tolerance.

What should be monitored after AROM?

Fetal heart rate, color, odor, and amount of amniotic fluid, and maternal temperature for infection risk.

What is the significance of the Bishop score?

It assesses the cervix's readiness for labor; a score ≤ 6 indicates an unfavorable cervix.

What is the role of prostaglandins in cervical ripening?

Prostaglandins help to soften and dilate the cervix, facilitating labor.

What is the expected outcome of using a CRB?

The balloon often falls out on its own once the cervix reaches about 3-4 cm dilation.

What should be done if signs of infection appear during cervical ripening?

Notify the healthcare provider immediately.

What is the common timeframe for labor to start after membrane stripping?

Labor may start within 24-48 hours.

What are the contraindications for AROM?

Latent phase (≤ 5 cm), if the fetal head is not engaged, or if there are concerns about presentation or position.

What are tocolytics used for?

To promote uterine relaxation.

What can cause uterine hypertonicity?

Placental abruption, chorioamnionitis, obstruction (tumors, adhesions), multiple gestation, and strong natural response to labor.

What is the primary management strategy for uterine hypertonicity?

Manage the underlying cause and may need immediate delivery.

What is a rare cause of seizures during labor associated with oxytocin?

Water intoxication.

What is the antidiuretic effect of oxytocin?

It can cause cells to swell, which is dangerous for brain cells.

What should be monitored during oxytocin infusions?

Urine output and vital signs.

What is the half-life of oxytocin?

Approximately 1-5 minutes.

What is Syntocinon?

A synthetic form of oxytocin used for inducing labor.

What is a significant risk associated with the use of Syntocinon?

Increased chance of needing other interventions and risk of postpartum hemorrhage (PPH).

What is the purpose of administering oxytocin after cervical ripening?

To augment existing contractions.

What is labor dystocia?

Failure to progress in active labor, characterized by delayed or arrested cervical dilation or descent.

What distinguishes shoulder dystocia from labor dystocia?

Shoulder dystocia occurs after head delivery when shoulders are stuck, while labor dystocia is slow or stalled progress before birth.

What are the four Ps that contribute to labor dystocia?

Powers (contractions), Passenger (fetal size/position), Passageway (maternal pelvis), and Psyche (maternal emotional state).

What nursing interventions can help address ineffective contractions?

Reposition the patient, encourage ambulation, hydration, and relaxation.

What should be done if no improvement in labor progress is observed?

Notify the provider; they may order oxytocin augmentation.

What is the significance of monitoring peripad counts during labor?

To watch for signs of postpartum hemorrhage (PPH).

What is the role of oxytocin in the context of postpartum hemorrhage?

It is administered to help control bleeding after delivery.

What is the effect of oxytocin on the cervix?

It helps ripen the cervix and triggers the endorphin effect.

What should be done if a patient is experiencing signs of water intoxication?

Stop oxytocin, restrict fluids, and correct electrolyte imbalances.

What is the expected outcome of oxytocin administration during labor?

Regular contractions and progression of labor.

What is the importance of a calm environment during labor?

It can help reduce maternal stress and restore labor progress.

What is the purpose of cervical ripening methods?

To help dilate the cervix before labor induction.

Which pharmacological method is used for cervical ripening?

Cervidil.

What is the primary purpose of oxytocin in a patient with a firm, posterior cervix at 1 cm dilation?

To augment existing contractions after cervical ripening.

What is the recommended fluid type for administering oxytocin?

Isotonic electrolyte solution, such as saline.

What should be expected if a patient is not having any contractions at 42 weeks gestation?

Cervical ripening methods should be initiated.

What is the relationship between oxytocin and the bonding hormone?

Oxytocin acts as a bonding hormone between mother and baby.

What is considered a Precipitous Labor?

Delivery that occurs within less than 3 hours of the onset of regular uterine contractions.

What are regular uterine contractions characterized by?

Rhythmic, coordinated tightening and relaxation of the uterus that occur at consistent intervals, increase in frequency, duration, and intensity over time, and result in progressive cervical change.

What are some risks associated with Precipitous Labor?

Increased risk for postpartum hemorrhage (PPH), tearing or laceration, and infection to the baby or mother if birth occurs in an unsterilized environment.

What are common methods to augment labor?

IV syntocinon (Pitocin) and artificial rupture of membranes (AROM).

What indicates safe administration of oxytocin during labor augmentation?

Contractions every 2-3 minutes, lasting 60 seconds, with a fetal heart rate showing moderate variability and no decelerations.

What are the risks associated with synthetic oxytocin?

Uterine hyperstimulation, fetal distress, uterine rupture, and water intoxication.

What is the nursing focus during Stage 1 of labor?

Support progress, monitor contractions, and consider augmentation only in the active phase.

What is the significance of maternal height in labor progression?

Short maternal stature (less than 5ft tall) can contribute to difficulties in labor progression.

What is the impact of fetal position on labor?

Occiput posterior position (OP) can make it harder for the fetus to pass through the pelvis, increasing pain and risk for labor dystocia.

What is the definition of Dystocia?

Problems with the passenger (fetus) that complicate labor.

What are the classifications of Hypertensive Disorders of Pregnancy?

Pregnancy Induced Hypertension (PIH), Gestational Hypertension (GH), Preeclampsia, and Eclampsia.

What are the criteria for diagnosing Preeclampsia?

Systolic blood pressure ≥ 140 mmHg and/or Diastolic ≥ 90 mmHg with proteinuria or severe complications.

What are common adverse conditions associated with Preeclampsia?

Headache, visual disturbances, abdominal pain, nausea/vomiting, and abnormal maternal lab values.

What are potential maternal consequences of Preeclampsia?

Stroke, pulmonary edema, hepatic failure, seizures, and placental abruption.

What are fetal risks associated with Preeclampsia?

Intrauterine growth restriction (IUGR), oligohydramnios, and fetal compromise.

What factors increase the risk of developing Gestational Hypertension?

Nullipara status, previous history of hypertension, poor nutrition, obesity, ethnicity, and advanced maternal age.

What is the importance of monitoring contraction patterns during labor augmentation?

To assess how the uterus and fetus are coping and to prevent complications such as uterine hyperstimulation.

What is the role of oxytocin in labor management?

Oxytocin is used to induce or augment labor but requires careful monitoring due to its high-alert status.

What should be done if oxytocin infusion does not achieve stable contractions?

Stop the infusion, assess the situation, and intervene before resuming.

What is the definition of macrosomia in the context of labor?

A condition where the fetus is larger than average, which can complicate labor.

What is the significance of the term 'primip' in labor?

It refers to a woman who has not had a baby before, which can impact labor progression.