Induction and Augmentation of Labor Flashcards Preview

NURS787 Exam 3 > Induction and Augmentation of Labor > Flashcards

Flashcards in Induction and Augmentation of Labor Deck (43):
1

List maternal indications for IOL

1) DM
2) renal disease
3) chronic pulmonary disease
4) cholestasis of pregnancy
5) gHTN or pre-eclampsia w/out severe features @ 37w
6) pre-eclampsia w/ severe features = ASAP
7) >41w GA - recommended at 42w0; indicated at 42w6d
8) chorioamnionitis
9) PROM after 34w

2

List fetal indications for IOL

1) IUGR
2) isoimmunization
3) non-reassuring fetal testing
4) multiple gestation
5) oligohydramnios
6) IUFD

3

What are contraindications to IOL?

1) problems of placentation (e.g. previa, prolapse)
2) hx myomectomy entering endometrial cavity
3) classical uterine incision
4) transverse lie
5) Cat 3 FHT
6) active genital herpes
7) elective IOL at <39w

4

What are maternal clinical considerations prior to IOL?

1) valid indication
2) no contraindications to vaginal labor/delivery
3) pelvimetry
4) Bishop score via cervical exam
5) review risks, benefits, alternatives to IOL

5

What are fetal clinical considerations prior to IOL?

1) GA based on final EDD - fetal lung maturity
2) fetal presentation and lie
3) EFW
4) Confirm Cat 1 FHT

6

What are risk factors for failed IOL?

1) nulliparity
2) post-EDC
3) low Bishop score
4) shorter stature
5) higher BMI

7

Describe Bishop scoring system

an assessment of cervical status to determine success of IOL

- >/= 8 --> favorable cervix
- =6 --> unfavorable cervix; may require ripening

0: posterior, firm, cervical length >4cm, 0/-3
1: midline, medium, 2-4cm, 1-2/-2
2: anterior, soft, 1-2cm, 3-4/-1 to 0
3: cervical length <1cm, >5cm/+1 to +2

8

Describe the latent phase of labor according to Zhang's labor curve

regular, q10-20min, uterine ctxns lasting 15-20s --> intensifies to q5-7mins, lasting 30-40s

9

Describe active labor according to Zhang's labor curve

cervical dilation starts at ~6cm --> ends with complete dilation
- nullips: 0.5-0.7cm/h or faster
- multips: 0.5-1.3cm/h

10

What are the 4 Ps?

1) powers
2) passenger
3) passageway
4) psyche

11

What are considered adequate contractions on pitocin?

q2-3mins lasting 60-90s

50-60 peak, 10-15 resting tone

150-350 MVUs

12

What is therapeutic rest?

"treats" prolonged latent phase

morphine sulfate IM +/- phenergan or vistaril

13

What is dx for protracted active phase?

multips: <0.5 - 1.5cm/h
nullips: <0.5 to 1.2cm/h

14

What is dx for arrest of active phase?

6cm or more, ROM, + one of following:
- 4h+ of adequate ctxn (>200MVU)
- 6h+ of inadequate ctxn

15

What is the mean duration of the second stage?

nullips: 50-60min
multips: 20-30mins

no max length identified

16

What is dx for protraction descent?

nullips: <1cm/h
multips: <2cm/h

17

What is dx for arrest of descent?

0 descent - time period not officially identified

nullips: 3h
multips: 2h
+1h for epidural

18

What are risks of >2h second stage?

1) low 5 min APGAR
2) increased neonatal depression
3) NICU admission
4) perineal trauma
5) chorio
6) PPH
7) instrumental deliveries

19

What are risk factors affecting length of the second stage?

1) parity
2) birth weight
3) OP position
4) BMI
5) epidural anesthesia
6) fetal station at complete dilation
7) delayed pushing

20

What are indications for C/S in the setting of IOL or augmentation?

1) >/= 6cm, ROM, and no cervical change over 4h
2) no cervical change in 6h of pit + inadequate uterine activity
3) failed induction = little to no cervical change for at least 24h in setting of pit + ROM

21

List cervical ripening agents

1) prostaglandin E2: dinoprostone (Cervidil or Prepidil)
2) prostaglandin E1: misoprostol (Cytotec) *off-label*

22

What are cervical ripening agents contraindicated?

1) prior to 40w GA
2) uterine scarring

23

What is the MOA of prostaglandins?

increase submucosal water content of cervix --> dissolution of collagen bundles

24

How should FHT be monitored during cervical ripening?

EFM for 0.5-2h

Continue to monitor if regular ctxns continue

25

Prepidil

0.5mg gel in 2.5mL syringe q6-12h

max 3 doses = 1.5mg

pit can start 6-12h after last dose

26

Cervidil

10mg (0.3mg/h) q6h

max 3 doses = 30mg

pit can start 30-60min after removal

27

Cytotec

25mcg per vagina q3-6h
- mostly likely for vaginal birth w/in 24h
- most likely for tachysystole

25-50mcg PO q3-6h
- lowest c/s rate
- less PPH and better NB outcomes

pit can start 4h after last dose

28

What is Cytotec contraindicated in cervical ripening?

- uterine scars
- >3 ctxns in 10 mins

29

What is a contraindication to dilation w/ balloon?

placenta previa; low-lying placenta

30

true or false:

Balloons take longer than prostaglandins to ripen a cervix.

false

may even be faster when used w/ another agent

31

What is the mechanism of membrane stripping?

releases prostaglandins --> ripening

32

Describe a typical dose of castor oil

2oz or 60mL in 2 doses

33

What are the adverse effects of castor oil?

DIARRHEA!

--> dehydration - PO 8oz fluids w/ electrolytes q1h

34

List uterotonic agents

1) oxytocin (Pitocin, Syntocinon)
2) nipple stimulation

35

contraindications to oxytocin

- inclusive of contraindications to NSVD
- pulmonary edema
- inappropriate staffing ratios

36

Why is pulmonary edema a contraindication to the use of oxytocin?

oxytocin = antidiuretic

--> inc edema, water toxicity, hyponatremia

37

What steps should be taken in the case of fetal compromise while augmenting with pitocin?

1) move to lateral position
2) +/- fluid bolus and terbutaline 0.25mg subQ
3) notify physician
4) restart after 15-30mins of Cat 1 FHT

38

When should oxytocin be discontinued?

- after 10-12h (if not in active labor)
- once active labor has begun

39

How is nipple stimulation performed?

roll one or both nipples with fingers OR use breast pump for 2mins, stop for 2mins, etc until contractions begin

40

What is the most common risk of AROM?

infection (e.g. chorioamnionitis, endometritis)

41

What is the most severe risk of AROM?

cord prolapse

42

What are indications for augmentation of labor?

labor dystocia

1) >/= 4h w/out cervical change after 5cm
2) prolonged latent phase

43

When is augmentation of labor contraindicated?

1) active phase arrest (>/= 6cm), ROM, no change for 4+hours
2) >/= 6h w/ presence of inadequate contractions
3) inclusive of contraindications for laboring