labor (2)

Power During Labor

  • Power during labor derives from:
      - Strong contractions of the upper uterine segment
      - In the 2nd stage, power is enhanced by the involvement of abdominal muscles

Use of Drugs in Labor

  • Purpose of drugs:
      - Ripen (soften and efface) the cervix
      - Induce (to begin) labor
      - Augment (to add to) labor

  • Action of drugs:
      - Stimulate uterine contractions

  • Examples of Drugs:
      - Prostaglandins:
        - Cervidil (a vaginal insert containing dinoprostone)
        - Cytotec (a vaginal or oral tablet containing misoprostol)
      - Oxytocin (synthetic hormone used to induce labor)

Common Reasons for Induction

  • Most common reasons for induction include:
      1) [Specific reasons not provided]
      2) [Additional specifics not provided]
      - Other reasons:
        - [Other reasons not specified]

General Contraindications for Induction

  • Contraindications include:
      - Undiagnosed vaginal bleeding
      - Any fetal distress detected on non-stress test (NST)
      - Active genital herpes infection
      - History of classic uterine surgery
      - Abnormal fetal presentation or lie
      - Placenta previa (low-lying placenta)

Bishop Score

  • Purpose of Bishop Score:
      - A scoring system used to assess cervical readiness or favorability for induction of labor

  • Criteria for scoring:
      - Softness (cervical consistency)
      - Dilation
      - Effacement
      - Station
      - Position of the cervix

  • Scoring:
      - 0-2 points awarded for each category
      - Score interpretation:
        - Score > 8 indicates cervical readiness for induction
        - Score < 6 indicates cervical ripening is needed

Cervical Ripening Agents

  • Function:
      - Used to soften, dilate, and efface the cervix in preparation for labor induction

  • Examples:
      - Prostaglandins (not for use if there is a prior uterine scar)
      - Evening primrose oil (administered vaginally or orally)
      - Herbal remedies (e.g., red raspberry leaves, black cohosh)
      - Mechanical dilation using balloon catheter
      - “Stripping” of membranes
      - Castor oil (taken orally)
      - Sexual intercourse with breast stimulation

Induction of Labor

  • Definition:
      - Stimulation of uterine contractions with a medical indication

  • Requirements for induction:
      - Clear medical indication for induction
      - If elective, must be > [weeks not specified] weeks gestation
      - Must have Category [not specified] Fetal Heart Rate (FHR) pattern prior to starting induction
      - Oxytocin should be infused piggyback on [pump type not specified]
      - Titrate carefully, beginning at 2 milliunits/minute
      - Monitor FHR and contraction pattern every 15 minutes during first stage of labor

Risks of Oxytocin

  • Possible risks include:
      - Uterine hyperstimulation
        - Management of too frequent contractions: [specific actions not provided]
      - Fetal distress
        - Management for Category 3 FHR: [specific actions not provided]
      - Uterine rupture
      - Water intoxication
        - Signs of water intoxication include: poor urine output, [further symptoms not specified] & [further symptoms not specified]

Safe Use of Oxytocin

  • Best Practices:
      - Know the standard of care!
      - Follow protocols precisely
      - Start oxytocin infusion slowly and evaluate before advancing
      - Monitor patient closely; check vital signs and fetal condition frequently
      - Understand side effects
      - When to hold or adjust infusion? Collaborate with the healthcare team!
      - Educate the patient about the induction process and medications used.