Induction of Labor Definitions Favorable cervix Bishops score

Induction of Labor Definitions ● Favorable cervix: Bishops score of >8 although no standard definition, dilation is most important ● Cervical ripening: softening of the cervix if unfavorable Bishop score or < 3 cm dilated ● Tachysystole: >5 contractions in 10 mins averaged over 30 mins, applies to both spontaneous and stimulated labor. Qualify by presence or absence of decelerations MCH Logistics ● Write =Obinductionnote as progress note when starting induction ● Need labor progress notes min q 4 hours Methods for Cervical Ripening ● Misoprostol **Contraindicated in TOLAC** ● Foley/Cook Catheter – No miso for 2 hrs s/p placement Risks of induction agents ● For Misoprostol or oxytocin: Tachysystole – >uterine rupture, placental abruption, fetal stress ● For Mechanical ripening: placental abruption, pain Updated 4/20

Induction of Labor Misoprostol ● 25 mcg PO q 2 hr or 50 mcg q 4 hr can be used at night or to allow ambulation ● 25 mcg vaginally q 4 hr (if after 2 doses there are insignificant contractions, may increase to 50 mcg/dose) ● Can re-dose if < 3 contractions in a 10 minute period and no cervical change ● Maximum of 300 mcg Oxytocin Standard Dosing at UNM (routine) ○ Start at 2 MU/min (2 m. L/hr) ○ Increase by 2 MU/min (2 m. L/hr) every 30 minutes until a dose of 12 mu/min. Can then increase by 2 -4 mu/min every 30 minutes until adequate contraction pattern or max 36 MU/min (36 m. L/hr) has been achieved Low Dose Regime (slow) - Use for TOLAC ○ Start at 1 MU/min (1 m. L/hr) ○ Increase by 1 MU/min (2 m. L/hr) every 30 minutes until 12 mu/min. Can then increase at 1 -2 mu/min every 30 minutes adequate contraction pattern or max 36 MU/min has been achieved. Attending Tips If not progressing with regular contractions, consider AROM. Cook and miso can be used together to speed induction Cook can be left in for 12 -18 hours Can stop pitocin or give terbutaline for tachysystole Adequate Contractions defined as: ● Ctx q 2 -3 minutes OR ● >200 Montevideo units are achieved by an intra-uterine pressure catheter Updated April 2020