Labor Augmentation and AROM Quiz

Augmentation of Labor

• Stimulation of ineffective uterine contractions after labor has begun
• Pitocin (oxytocin) is the most common method
• Diluted in isotonic solution (e.g., normal saline) and administered IVPB
• Start slowly and titrate to uterine contractions and fetal response
• Monitor fetal heart rate (FHR) baseline and throughout labor
• Watch for signs of hyperstimulation/tachysystole
• Monitor for uterine rupture, maternal water intoxication (oxytocin is an antidiuretic), and increased risk of postpartum hemorrhage (PPH)

AROM (Amniotomy/Artificial Rupture of Membranes)

• Risks include:
  • Cord prolapse
  • Infection
  • Abruption (especially with polyhydramnios)
• Post-procedure interventions:
  • Monitor FHR for reassuring patterns
  • Assess and document amniotic fluid (color, odor, amount)
  • Monitor fetal temperature every 2 hours
  • Administer antibiotics for ROM lasting 18+ hours
  • Minimize upright positions/walking until head is engaged
  • Monitor for abnormal fluid (blood, meconium)
  • Notify neonatology team and pediatrician for anticipated deep suction at delivery

Internal Monitoring

• Fetal scalp electrode (FSE) for accurate beat-to-beat variability
  • Sterile technique required, within RN scope
  • Avoid sutures/fontanels
• Internal pressure catheter for accurate contraction strength
  • Can be used to monitor and titrate Pitocin
  • May be used with amnioinfusion
  • Helps minimize uterine rupture risk

Version

• Changing fetal presentation to cephalic for vaginal delivery (prevents c-section)

Dysfunctional Labor: Dystocia

• Difficult labor due to ineffective dilation, effacement, and descent
  • Problems with the powers (uterine contractions), passenger (fetus), passage (birth canal), position, and psyche
• Types:
  • Hypotonic: ineffective, exhausting uterine contractions (more common in active labor)
  • Hypertonic: uncoordinated, painful contractions (more common in latent labor)
  • Multifetal pregnancy: increase risk

Secondary Powers/Position/Psyche

• Risk factors
  • Ineffective pushing technique or position
  • Fear of pain or injury
  • Insufficient urge to push
  • Exhaustion and psychological distress
• Interventions:
  • Provide assistance and guidance during pushing
  • Provide comfort and support
  • Encourage the use of upright positioning as tolerated to aid in pushing

Passenger/s

• Large for gestational age (LGA)
  • Shoulder dystocia is a risk

Prolapsed Cord

• Umbilical cord displaces between presenting part and the amniotic sac, or protrudes through the cervix.
• Symptoms: cord visible or reported by mother. Bradycardia, variable decelerations in FHR, and/or decreased fetal activity from cord pressure.
• Risk factors: Polyhydramnios, small fetus, fetus at high station (-2 or -3).
• Interventions: relieve cord pressure (positioning, placing sterile gloved hand under the presenting part to keep it off the cord).

Uterine Rupture

• Separation of uterine tissue due to a tear in the uterine wall.
• Risk factors: Previous uterine surgery (e.g., c-section), polyhydramnios, multifetal pregnancy, abdominal trauma, large or multiple pregnancies.
• Symptoms: Severe abdominal pain (possibly between shoulder blades or radiating to the chest), possible hypovolemic shock (internal hemorrhage) and/or sudden absence of fetal heart tones and contractions.

Amniotic Fluid Embolism

• Amniotic fluid enters maternal circulation.
• Possible cause: uterine hyperstimulation/trauma, large-for-gestational-age fetus, previous pregnancy complications.
• Risk factors: hyperstimulation of uterus, molar pregnancy, large fetus, presence of meconium in fluid.
• Immediate management: CV stabilization, CPR, oxygen, fluid replacement, possible blood products like packed red blood cells (PRBCs) and/or fresh frozen plasma (FFP) as needed.

Other

• Preterm labor: Weeks 20-37 of gestation, infection primary risk. Assessment of uterine activity, cervical change, pain, discharge, and rupture of membranes.
• Prolonged Pregnancy after 42 weeks gestation. Aging placenta/interruption of nutrition and oxygenation to fetus with potential fetal distress and oligohydramnios/cord compression.
• Variable, late decelerations in fetal heart rate monitoring and interpretation.