Managing Complications in Pregnancy and Childbirth: - IAWG

P-20 Induction and augmentation of labour• Review for indications.Be sure induction is indicated, as failed induction is usuallyfollowed by caesarean section.• Ensure that the woman is on her left side.• Record the following observations on a partograph every 30minutes (page C-65):- rate of infusion of oxytocin (see below);Note: Changes in arm position may alter the flow rate;- duration and frequency of contractions;- fetal heart rate. Listen every 30 minutes, always immediatelyafter a contraction. If the fetal heart rate is less than 100 beatsper minute, stop the infusion.Women receiving oxytocin should never be left alone.• Infuse oxytocin 2.5 units in 500 mL of dextrose (or normal saline) at10 drops per minute (Table P-7, page P-22 and Table P-8, page P-23). This is approximately 2.5 mIU per minute.• Increase the infusion rate by 10 drops per minute every 30 minutesuntil a good contraction pattern is established (contractions lastingmore than 40 seconds and occurring three times in 10 minutes).• Maintain this rate until delivery is completed.• If hyperstimulation occurs (any contraction lasts longer than 60seconds), or if there are more than four contractions in 10minutes, stop the infusion and relax the uterus using tocolytics:- terbutaline 250 mcg IV slowly over 5 minutes;- OR salbutamol 10 mg in 1 L IV fluids (normal saline or Ringer’slactate) at 10 drops per minute.• If there are not three contractions in 10 minutes, each lastingmore than 40 seconds with the infusion rate at 60 drops perminute: