Chapter 27 Birth-Related Procedures

- Prostaglandin E2 or PGE2 gel is used for cervical ripening

- This helps with softening and effacing the cervix

- It is used in women at or near term for the induction of labor

- Prepidil a form of PGE2 gel is a intracervical application

- Cervidil is a intravaginal insert, it is 2-cm-square piece of cardboard like material and placed on the posterior vagina. It is slow releasing

• can be removed easliy
• causes cervical ripening
• shorter labor
• lower requirements for oxytocin
• vaginal birth w/in 24 hrs
• reduced need for C-section

• uterine hyperstimulation
• nonreassuring fetal status
• higher incidence of postpartum hemorrhage
• uterine rupture in absence of previous incision

• previous uterine incision (C-section)
• compromised cardiovascular
• hepatic or renal function
• women with asthma or glaucoma
• sensitivity to PGE2
• unexplained vaginal bleeding

• used only by hospital birthing unit
• comes in prefilled syringe
• a catheter is inserted into the endocervix
• gel is injected
• cath has sheild so gel can't pass to internal os

• vaginal insert is placed in the posterior vagina
• if it becomes dislodge reinsert by nurse
• if hyperstimulation occurs remove insert
• if active labor occurs remove insert

• a synthetic PGE1
• used to soften and ripen the cervix to induce labor
• available in tablet of insert
• increased rate of uterine rupture
• delivery w/in 24 hours
• low ceserean birth rates

• use one in 3rd trimester for ripening and induction
• 1/4 of tab or 25 mcg for initial dose
• wait 4 hours before Pitocin is given

• three uterine contractions in 10 minutes
• maternal asthma
• previous cesarean or other uterine scar
• placenta previa
• nonreassuring fetal status

• this is the use of a balloon catheter
• used for cervical ripening and mechanical dilation
• a 25 mL to 80 mL balloon is used to dilate the cervix with inflation
• can be used w/ vaginal Cytotec, Pitocin, or extra-amniotic saline infusion

• assess maternal vital signs
• apply EFM
• intruct women to remain lying down after insertion
• put rolled blanket or wedge under right hip to shift uterus
• monitor for hyperstimulation
• monitor FHR abnormalities
• administer tocolytic if hyperstimulation occurs
• give antiemetics, antipyretics and antidiarrheal agents
• assess location of cathether
• women should remain in recumbent position
• no vaginal examinations
• provide bedpan avoid ambulation

Is the stimulation of uterine contractions before the spontaneous onset of labor, with or w/o ROM, for the purpose of accomplishing birth

Is the stimulation of uterine contractions when spontaneous contractions have failed to result in progresssive cervical kiationor the descent of the fetus

• DM
• Renal disease
• Preeclampsia
• HTN disorders
• PROM
• Chorioamnionitis
• Fetal demise
• Postterm gestation
• IUGR
• Isoimmunization
• Hx of rapid labor or precipitous labor
• Nonreassuring antepartal testin
• Severe oligohydramnios
• Macrosomia

• abnormal FHR patterns
• breech presentations
• unknown presentations
• multiple gestation
• polyhydramnios
• presenting fetal part above the maternal inlet
• severe HTN
• maternal heart disease

• Stripping membranes
• nonpharmalogic method
• physician inserts fingers as far as possible into internal cervical os
• rotates the finger 360 degrees, twice
• motion seperates the amniotic membranes
• stripping is thought to release PGF2oc from amniotic membranes or PGE2 from cervix
• after procedure: uterine contractions, cramping, and bloody discharge can occur

• Oxytocin infusion:
• requires IV adminstration
• intiates uterine contractions to induce labor
• goal is to achieve 3 UCs in 40-60 seconds in 10 min

• Complementary methods:
• sexual intercouse/love making:-)
• self or partner stimulation of women's nipple
• blue/black cohosh
• evening primrose oil
• red rapberry leaves
• homeopathic solutions: caulophyllum, pulsatilla
• castor oil
• acupressure/acupuncture

• obtain vital signs
• begin oxytocin infusion
• obtain fetal monitor recording
• inform women of blood tinge d/c from procedure
• monitor frequency, intensity, and duration

• it is artificial rupture of amniotic membranes
• most common procedure for induction of labor
• the cervix has to be dilated at least 2 cm
• can be used to augment labor too
• labor will be shortened 1-2 hours
• allows you to insert a fetal monitor electrode
• allows you to insert intrauterine pressure cath

• contractions elicited are similiar to SROM
• women does not require intensive monitoring as with oxytocin
• EFM is possible
• color and composition of fluid can be evaluated

• birth needs to happen w/in 24 hours b/c of increase risk for infection
• danger of prolapsed cord is increased esp. if presenting part is not pressed down on cervix
• molding and compression of fetal head b/c of loss of amnio fluid
• fetal injury due to the amniohook
• bleeding due to undiagnosed vasa previa
• severe variable decels which increases C-section

• first assess fetus presentation, position, station, and FHR
• physician introduces an amniohook into vagina, through the cervix, and against the amniotic membrane
• a small tear is made in the amniotic membrane
• amniotic fluid is now allowed to escape slowly

• Assess fetal presentation, position, and station (amniotomy is usually delayed until engagement)
• Place disposable pads and towel under buttocks
• Assess FHR immediately before and after amniotomy
• Check for prolapsed cord
• Inspect amnio fluid for amount, color, odor, meconium and blood
• Clean and dry perineal area
• Advise women fluid will continue to come out
• Strict sterile technique vaginal exam should be used
• Reduce the amount of vaginal exams done b/c of increase infection
• Monitor temperature every 2 hours
• Bed rest is maintained

Is a technique by which a volu