- The deliberate initiation of labor before spontaneous contractions begin may be either mechanical (amniotomy [ie, rupture of amniotic membranes]), physiologic (ambulation and nipple stimulation), or chemical (prostaglandins and oxytocin).
- Artificial rupture of membranes (AROM) may be adequate stimulation to initiate contractions, or AROM may be done after oxytocin administration establishes effective contractions.
- Induction and AROM are initiated when the cervix is soft, partially effaced, and slightly dilated, preferably when the fetal presenting part is engaged.
- Oxytocin-induced labor must be done with careful, ongoing monitoring; oxytocin is a powerful drug. Hyperstimulation of the uterus may result in tonic contractions prolonged to more than 90 seconds, which could cause fetal compromise due to impaired uteroplacental perfusion, abruption placentae, and laceration of the cervix, uterine rupture, and neonatal trauma.
1. Monitor for safe labor and delivery process.
- Explain the procedure, and inform the client that labor usually follows within 6 to 8 hours of AROM.
- Monitor fetal heart tones immediately before, during, and after the procedure.
- Observe and record color, amount, and odor of amniotic fluid; time of procedure; cervical status; and materbal temperature.
- Take and record the client’s temperature every 2 hours to assess for infection.
- Monitor for the onset of labor.
b. Medication- induced labor (see Table 1)
Medication Used for Intrapartum Complications
|Classifications||Used for||Selected Interventions|
Dinoprostone (Prepidil, Prostin E2 [suppository or gel]
|Stimulates uterine smooth muscle to contractInitiates softening, effacement, and dilation of the cervix||Suppository (prostaglandin) is inserted every 2 hours times 3.Keep the suppository cold and bring it to room temperature before insertion. After insertion, have the client remain dorsal recumbent for 15-30 min.The gel is inserted into the cervical os by catheter two times; 6 hours apart.Monitor for the following side effects: headache, nausea, vomiting, hypotension, hypertension, dyspnea, and uterine hyperstimulation.|
Oxytocin (Pitocin, Syntocinon [intravenous drip])
|Used for induction of labor|| Oxytocicn is infused at a rate of 1-2 mU/min and increased by 1-2 mU/min every 15-30 minutes until a contraction pattern is establishedMonitor vital signs and fetal heart rate closely.Assess the contractile pattern.Limit IV fluids to 150 mL/hour.
Mix 10 IU oxytocin in 1000 mL Ringer’s lactate and hang as a “piggy back” solution. Always use the infusion port closest to the client.
Monitor for water intoxication.
- Review the hospital’s policy relative to the amount, rate, and interval for increasing oxytocin or a prostaglandin- based preparation.
- Use an infusion pump for precise regulation of the medication.
- Observe for signs of hypertonicity, such as contractions exceeding 75 mm Hg (when using the internal pressure catheter), exceeding 90 seconds, or closer than 2 minutes. Be prepared to discontinue the medication immediately.
- Initiate continuous internal or external fetal monitoring, and evaluate for normal range of 110 to 120 to 150 to 160 beats/ min. If there is loss of variability, late decelerations, or persistent bradycardia (fewer than 120 beats /min), discontinue medication, administer oxygen notify physician, reposition client to side lying position, and perform a vaginal examination; fetal distress may result from rapid labor progress, descent of fetus, or cord prolapse.
- Assess and record vital signs and fetal heart rate (FHR) every 15 to 30 minutes, depending on the stage of labor and risk status; assess for signs of impending delivery.