Module 8: Precipitate Labor and Induction of Labor

Precipitate Labor

• Precipitate labor and birth occur when uterine contractions are so strong that a woman gives birth with only a few, rapidly occurring contractions.
• It is often defined as a labor that is completed in fewer than 3 hours.
• Precipitate dilatation is cervical dilatation that occurs at a rate of 5 cm or more per hour in a primipara or 10 cm or more per hour in a multipara.
• It is likely to occur with grand multiparity, or it may occur after induction of labor by oxytocin or amniotomy.
• It can lead to: premature separation of the placenta, subdural hemorrhage to fetus, & lacerations of the birth canal.

Induction and Augmentation of Labor

• Induction of labor means that labor is started artificially.
• Augmentation of labor refers to assisting labor that has started spontaneously but is not effective.
• The primary reasons for inducing labor include the presence of pre-eclampsia; eclampsia; severe hypertension; diabetes; Rh sensitization; prolonged rupture of the membranes; intrauterine growth restriction; and post maturity.
• Augmentation of labor or assistance to make uterine contractions stronger may be necessary if the contractions are hypotonic or too weak or infrequent to be effective.
• Use cautiously for women with a multiple gestation, hydramnios, grand parity, maternal age older than 40 years, or previous uterine scars.

Conditions for Induction of Labor

• The fetus is in a longitudinal lie.
• The cervix is ripe, or ready for birth.
• A presenting part is engaged.
• There is no CPD.
• The fetus is estimated to be mature by date, demonstrated by a lecithin–sphingomyelin ratio or ultrasound biparietal diameter to rule out preterm birth.

Cervical Ripening

• Cervical ripening, or a change in the cervical consistency from firm to soft, is the first step the uterus must complete in early labor.
• Methods of cervical ripening include:
• Stripping the membranes
• Using hygroscopic suppositories
• Applying a prostaglandin gel, such as misoprostol, to the interior surface of the cervix by a catheter or suppository

Induction of Labor by Oxytocin

• Administration of oxytocin (synthetic form of naturally occurring pituitary hormone) initiates contractions in a uterus at pregnancy term.
• Oxytocin is always administered intravenously, so that, if hyperstimulation should occur, it can be quickly discontinued.
• Oxytocin drip should be incremented/gradually increased in flow rate: max 20gtts/min
• After cervical dilatation reaches 4 cm, artificial rupture of the membranes may be performed to further induce labor, and the infusion may be d/c, but in some cases may still continue until full dilatation.

Explore the concept of precipitate labor and induction of labor in Module 8. Learn about the rapid progression of labor, cervical ripening, and induction methods such as oxytocin. Understand the implications and management of precipitate labor.