Question

Describe an evidence-based protocol for labor stimulation (augmentation and induction) and the nursing care management essential for the safe and compassionate implementation of the protocol.

Answer 1

Augmentation of labour: stimulating the uterus during labour to increase the frequency, duration and strength of contractions.

Induction of labour: stimulating the uterus to begin labour.

Protocol for labour stimulation:-

• Application of the recommendations should be based on consideration of the general condition of the woman and her baby, her wishes and preferences, and respect for her dignity and autonomy.
• Augmentation of labour should be performed only when there is a clear medical indication and the expected benefits outweigh the potential harms.
• Women undergoing augmentation of labour, particularly with oxytocin, should not be left unattended.
• Augmentation of labour with oxytocin is appropriate and should only be performed after conducting clinical assessment to exclude cephalopelvic disproportion. This principle is relevant for all women but is even more crucial for multiparous women.
• As the evidence for these recommendations was largely informed by studies conducted among women with pregnancies in cephalic presentation and unscarred uterus, they should not be applied to women with abnormal fetal presentation (including breech) or scarred uterus.
• Protocol for labor induction:-
• Prolonged pregnancy
• • Preterm prelabour rupture of membranes
• • Prelabour rupture of membranes
• • Presence of fetal growth restriction
• • Pevious caesarean section
• • History of precipitate labour
• • Maternal request
• • Breech presentation
• • Intrauterine fetal death
• • Suspected macrosomia.
• favourable or unfavourable cervix separately.
• 1.3 Areas outside of the remit of the guideline.
• • Women with diabetes
• • Women with multifetal pregnancy
• • Women undergoing augmentation (rather than induction) of labour. Augmentation of Labor
• This is done when the patient is already in labor. She's having contractions, however they are very mild or hypotonic (8-10 mins apart). They do not make the cervix dilate.
• - This process stimulates the uterine contractions after labor has already started.
• The patient is already dilated, the contractions are just not strong enough.

Nursing management of augmentation:-

• Encourage the Patient to Void, This is done before the start of induction of labor.
• Ensure Reactive Tracing (Monitor for 20 minutes before Induction). This is performed to make sure the Fetal Heart Rate is stable before induction. We don't want to start induction of labor for a patient already having decelerations.
• Cervidil (Prostaglandin E2)
• This is applied for 12 hours to the patient when they are admitted into the hospital.
• (Ex. applied 5pm, then removed 5am the following morning)
• - It helps soften the cervix and promote uterine contractions. Allows Pitocin to work properly.
• - Pitocin is started after the cervix is softened.
• Check FHR(1st PRIORITY), Presence of Meconium, and for Prolapsed Cord. These are necessary checks performed after a doctor ruptures the membrane.

• Monitor Temperature and Give AntibioticsThese are performed for patients who's membrane has ruptured prior to coming to the hospital. They are prone to infections.
• Monitor Q 2 - 4 hours
• Give Pitocin

• Pitocin Indications

These include:

- PROM

- Post Mature Fetus (42-43wks)

- Pre-eclampsia or eclampsia

- Multipara w/precipitous labor

2 - 3 minutes Apart

Increase Pitocin dosage until contractions reach this time interval.

- We don't want to see that contractions are every minute, with no resting period. If this happens, stop the Pitocin.

Decelerations in FHR

In this situation, you would NOT increase Pitocin. When this occurs, the baby is being squeezed by the Pitocin administration. This is not a sign of fetal well being.

Water intoxication & Urinary Retention

These are complications of Pitocin administration. Assess I&O.

Pitocin Contraindications

These include:

- Cephalo Pelvic Disproportion (CPD-disproportion btwn the babies head and the pelvis)

- Fetal Distress

- Non-reassuring FHR (Late/Variable Deceleration, no Variables)

- Prematurity

- Placenta Previa (Placenta before baby)

- Prior Classical C-Section (Can lead to rupture of the uterus)

- Hypertonic Uterine Contractions (Q1Min apart, too frequent)

Nursing management of induction of labour:-

Nursing Responsibilities During Labor Induction

With this:

- Immediatley after the membrane is ruptured, check FHR

- Check rate of infusion

- Check uterine contractions and FHR Q 15 min

- Monitor S&S of hypotension

- Water intoxication

- N/V check

Open Primary Line, Place in Lateral Position, Give O2 by face mask, and Notify MD

These are the primary nursing actions if a patient is experiencing Hyper stimulation of Pitocin.

rus.