Induction and Augmentation of Labor
Induction and augmentation of labor
-Artificial methods to stimulate uterine contractions -Induction rates more than doubled from 1990 to 2010, reaching all-time high of 23.8% -Inductions associated with higher cesarean rate -Focus on waiting until 39 weeks for elective inductions (unless medically indicated) has reduced cesarean rate ØHard stop policy with March of Dimes
Induction and Augmentation of Labor: RISKS
-Excessive uterine activity - we want 5 or less contractions in 10 mins -Uterine rupture - ↑increases with overdistention -Maternal water intoxication -Chorioamnionitis - prolonged rupture time -Cesarean birth - ↑ risk with induction of bishop score 7 or less -Postpartum hemorrhage
Induction and Augmentation of Labor: Indications
-Hostile intrauterine environment - Introuterine growth restriction, oligo, isoimmunization - mom has built up antibodies that are fighting the fetus -Spontaneous rupture of the membranes (SROM) -Postterm pregnancy -Chorioamnionitis (infection and inflammation of the amniotic sac) -Hypertension -Abruptio placentae -Maternal medical conditions that worsen with continuation of the pregnancy - heart condition or diabetes, epilepsy -Fetal demise
Induction and Augmentation of Labor: contradictions
-Placenta previa - partially or completely covering the cervical os -Vasa previa - umbilical cord not attached to the center of the placenta -Umbilical cord prolapse -Abnormal fetal presentation -Active genital herpes -Previous uterine surgery -Breech presentation -Overdistended uterus due to multifetal pregnancy or polyhydramnios -Severe maternal conditions such as heart disease and severe hypertension -Fetal presenting part above the pelvic inlet -Inability to monitor maternal fetal status adequately
Vaginal birth is more likely to occur with a BIshop score of
8 and up
Induction and Augmentation of Labor: Techniques
Determining whether induction is indicated ØCervical assessment (Bishop score) Table 15.2 p. 406 ØVag birth more likely with score of 8 or higher
Oxytocin is given
IV piggback
Induction and Augmentation of Labor: Nursing considerations
Observe fetal response ØTachysystole reduces placental blood flow •> 5 ctxs in a 10 minute period averaged over 30 mins •Assess need for terbutaline ØAssess FHR pattern ØReduce or stop infusion for nonreassuring FHR ØIV fluid bolus of at least 500 ml that can space out the uterine contractions ØSidelying position ØOxygen by nonrebreather 10L/min
Types of cervical dilators
Prostaglandin gel, Cervadil (dinoprostone), Misoprostol (cytotec)
Laminaria
mechanical cervical dilators
