Use of oxytocin and misoprostol for induction or ... - POPPHI

Term
Definition
minutes. See table 3.3a for doses and for comparison of high and low dose regimens.
There seems to be consensus that there be at least six hours interval between last
prostaglandin dose and first oxytocin dose(18-21). Preparations of oxytocin for
electronic infusion vary as well, but consensus is to have a standard practice in each
protocol to avoid confusion. To reduce the risks associated with excess IV fluid it is
suggested by RCOG to mix 10 IU in 500ml of IV fluid for a concentration of
20,000mU/L.
Preterm Generally defined between 24 and 37 weeks gestation. Term is between 37 and 42
weeks gestation. Postdates pregnancy is one that is one or two or more weeks past 40
weeks and is sometimes called prolonged pregnancy(18).
Monitoring
during
induction of
labor
Any labor including an induced one should be monitored using a WHO approved
partograph including pulse, blood pressure, contraction frequency, strength and length,
pv. Blood loss and fetal heart rate(23). Fetal heart rate (FHR) should be monitored
during an induction by external fetal monitor (EFM) or intermittent auscultation (IA)
(22). Some guidelines suggest constant external fetal monitoring in places where such
facilities exist (19, 20).
Fetal distress
Labor
Other methods
Hypertonus or
hyperstimulati
on of the
uterus
Signified by FHR abnormalities is ill defined (22) especially in low resource settings
where electronic fetal monitoring (EFM) may not be available. FHR outside the range
of normal 110-160 beats per minute is either prolonged or in decelerations. Fetal
condition may also be assessed by measuring fetal blood gasses via a scalp sample.
Fetal distress is more common with induced labors and may be the deciding factor for
operative delivery (22).
The process of uterine contractions leading to progressive effacement and dilation of the
cervix and birth of the baby. A good labor pattern indicates successful induction or
augmentation. A good labor pattern is described as three contractions in 10 minutes
each lasting more than 40 seconds. The uterus should relax between contractions (21).
Oxytocic dose should be maintained but not increased once this stage is achieved (18,
23).
Alternative methods of cervical ripening and labor induction include: nipple
stimulation to elicit natural oxytocin release in the pituitary to cause contractions, castor
oil which works as a stimulant laxative to encourage descent of the fetal head by
evacuation of the colon and may also stimulate uterine contractions(18, 19, 22, 23).
Contractions more frequent than 3 in 10 minutes and/or lasting longer than 60 seconds
in duration, with the uterus not relaxing between contractions. This protracted
contraction of the myometrial muscle causes constriction of the vessels supplying blood
to the uterus and to the placenta which can cause a separation of the placenta from the
uterus (placental abruption), or a lack of oxygen to the fetus resulting in fetal
compromise through asphyxia. Intrauterine pressure catheterization can be used to
measure the pressure of the contraction for accurate diagnosis. Any oxytocin infused
should be turned off immediately, and tocolytics considered in the case of
hyperstimulation(23).
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