Artificial Management of Labor

Bishop score

Determines maternal readiness for labor by evaluating whether the cervix is favorable by rating cervical dilation, effacement, consistency, position, and station

bishop score factors

-dilation

-effacement

-station

-consistency

-position

amniotomoy

AROM, used for labor induction, augmentation, internal fetal monitoring

-uses amniohook and only OB or mid-wife can do

once ROM

-check FHR

-document COAT

-check mom temp Q2 hr or sooner for infection

cervical ripening

the process of softening and thinning the cervix by a foley bulb

-risk for hyperstimulation, non reassuring fetal status, pph, uterine rupture

Cytotec (misoprostol)

-prostaglandin

-usually given vaginally to stimulate contractions to thin cervix

-do not give with oxy/pitocin within 4 hr of last dose

Cervidil (Dinoprostone)

-prostaglandin

-given vaginally to stimulate contractions to thin cervix

-tampon like

-bedrest 2 hours after dose

stripping of membranes

digital separation of the chorionic membrane from the wall of the cervix and lower uterine segment during a vaginal exam done by a primary care provider to stimulate labor.

oxytocin/pitocin

-used for labor induction or augmentation

-water intoxication (ADH like effect)

-need vag exam with bishop score before administering

-need reactive NST before starting

-overuse can cause extra bleeding

amnioinfusion

-warmed sterile NS or LR place in uterus via IUPC

-replacement of lost or absent amniotic fluid

-use for repetitive variable dcels with increasing intensity

-meconium dilution

-some fluid should leak back out

episiotomy

surgical incision of perineum to enlarge outlet, midline or mediolateral

-not recommended!

neonatal risk of forcep use

-elevated bilirubin level d/t bleeding or bruising

-caput succedaneum or cephalhematoma

c/s indications

Complete placental previa

CPD - baby is too big

Placental abruption

Active herpes outbreak

Umbilical cord prolapse

Breech/malabsorption

Non-reassuring FHR

Repeat C/S

classical vertical incision

-increase risk for uterine repture for next pregnancy, do not try vaginal

signs of imminent birth

-bulging of perineum

-crowning

-uncontrollable urge to bear down

-increase in bloody show

highest bishop score

13 over 8 is promising

long use of oxytocin can cause

hyponatremia and water intoxication which has confusion, lethargy, seizures, cerebral edema and NV as side effects

nursing management before c/s

-bolus warmed iv fluids

-worry abt hypotension

-give pepcid/reglan if unscheduled

-bicitra

-insert foley

-prep abdomen

facotrs needed for VBAC include

-adequate pelvis

-no hx of myomectomy

-anesthesia in house

epidural/spinal causes

hypotension! bolus IV fluids!!

systemic analgesia

-butorphanol (stadol)

-nalbuphine hydrochloride (nubain)

-meperidine (demerol)

-fentanyl (sublimaze)

-naloxone (narcan)

-N drugs are No No, can send baby/mom into withdrawl do not use on those with substance abuse hx

-can drop fetal variability NOT FHR

-FHR must be reassuring prior to administration

-can cause fetal respiratory depression, do not give if close to delivery

if hypotension after epidural/spinal placement

-give fluid bolus

-ephedrine

-oxygen

-assess fetal status