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1

the initiation of uterine contractions by artificial means before spontaneous labor

induction of labor

2

name some indications for induction of labor

abruptio placentae, choriamnioitis, fetal demise, hx of precipitous delivery, HTn disorder, PROM, post term pregnancy, Fetal compromise (IUGR, oligohydramnios)

3

5 component tool for predicting inducibility

Bishop score (the higher the # the more inducible), objective measurements

4

what are the 5 components of the Bishop score

position of cervix, consitency, effacement, dilation, baby's station

5

the higher the score the ______ inducible the women

more

6

what happens during the pathophysiology of induction (maternal and fetal factors)

*Uterine muscles- strecth, prostoglandin released
*cervical pressure- oxytocin is released
*inhibition of Ca binding- oxytocin & prostoglandin which causes contractions

7

what methods are used for induction

stimulate prostaglandin release, admin of prostaglandin, or admin of oxytocin

8

what alternative methods are used for induction

herbals (red rasberry tea, accupuncture, castor oil, nipple stimulation, intercourse

9

more then 5 contractions in 10 minutes when averaged over a 30 minute window

tachysystole (major risk factor when induce labor)

10

what is used to ripen/open the cervix and/or stimulate labor

dilators, prepidil, amniotomy, cervidil, misoprostol

11

amniotomy is also known as

rupture of membranes

12

ROM release what

prostoglandins

13

ROM that release prostoglandins which speed up contractions, done anytime before or during labor, but when done before labor it is considered an induction procedure

amniotomy

14

what are the risks with amniotomy

infection, prolapsed cord, compression of cord

15

when is amniotomy contraindicated

HIV (risk of trasmisison to NB), disengaged fetal head

16

what needs to be documented with amniotomy

FHR, temperature, fluid (amt., color, odor), time

17

examiner digitally frees membranes of amniotic sac from the lower segment of uterus around cervical os

membrane stripping

18

when is membrane stripping done

at term, prenatal appt

19

what does membrane stripping cause

prostaglandin release from sac/cervix, and labor within 48 hours

20

what are the risks of membrane stripping

accidental ROM, vaginal placenta

21

mechanical dilation with weighted balloon pressing on internal os

foley bulb dilator

22

what does the foley bulb dilator lead to the release of

prostaglandin release, cervical ripening, and uterine contractions

23

what are the advantages of the foley bulb dilator

low cost, small risk of tachysystole, decrease duration of labor, decrease risk of C/S

24

what are the risks of using foley bulb dilator

vaginal bleeding, ROM, infection

25

absorbs fluid from surrounding tissue causing a dilator effect on the cervical os,

hygroscopic dilators

26

what is laminaria made of

stem of seaweed, remove after 12-24 hours, repeat prn, risks are infection

27

PGE2 preparation in a vaginal insert placed in posterior vagina which releases prostaglandins at a slow rate (0.3mg/hr)

cervidil (slow release)

28

cervidil

remove prior to ROM, increases success of delivery within 24 hours, doesn't decrease risk of C/S, looks like shoe string (allows for easy removal)

29

risks with cervidil

tachysystole with FHR changes, PPH, uterine rupture, need to continue fetal/maternal monitoring for @ least 2 hours after removal

30

administration guidelines with cervidil

store in fridge, need to remain in bed 30 minutes after placement, if have too many ctx it must be removed, monitor uterine activity and FHR for minimum of 2 hours, if tachysystole occurs remove immediately, remove at onset of active labor or 12 hours after insertion, MUST remove before start of pitocin