A. DESCRIPTION
1. The deliberate initiation of labor before spontaneous contractions begin may be either mechanical (amniotomy [rupture of amniotic membranes]), physiologic (ambulation and nipple stimulation), or chemical (prostaglandins and oxytocin).
2.Artificial rupture of membranes (AROM) may be adequate stimulation to initiate contractions, or AROM may be done after oxytocin administration establishes effective contractions.
3. Induction and AROM are initiated when the cervix is soft, partially effaced, and slightly dilated, preferably when the fetal presenting part is engaged.
4. Oxytocin-induced labor must be done with careful, ongoing monitoring; oxytocin is a powerful drug. Hyperstimulation of the uterus may result is titanic contractions prolonged to more than 90 seconds, which could cause fetal compromise due to impaired uteroplacental perfusion, abruption placentae, laceration of the cervix, uterine rupture, or neonatal trauma.
B.NURSING MANAGEMENT
1.Monitor for a safe labor and delivery process.
a. AROM
- 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 maternal 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
-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 mmHg (when using the internal pressure catheter) or 90 seconds, or closer together than 2 minutes. Be prepared to discontinue the medication immediately.
- Initiate continuous internal or external fetal monitoring, and evaluate FHR for normal range of 110 to 160 beats/minute. If there is loss of variability, late deceleration, or persistent bradycardia (FHR less than 120 beats/minutes), 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 prolapsed.
- Assess and record vital signs and FHR every 15 to 30 minutes, depending on stage of labor and risk status; assess for signs of impending delivery.
2. Provide physical and emotional support.
