Labor Induction

Aka: Labor Induction, Pitocin Induction, Pitocin Augmentation, Labor Augmentation

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II. Documentation

  1. Indication for Labor Induction
  2. Estimated fetal weight
  3. Fetal Position by Ultrasound
  4. Lung maturity for elective induction before 39 weeks
  5. Normal Fetal Assessment

III. Indications

  1. Labor Augmentation
    1. Failure to Progress
  2. Labor Induction
    1. Bishop Score >= 5
      1. See Cervical Ripening for Bishop Score <5
    2. Rupture of Membranes

IV. Preparation: Pitocin in Normal Saline

  1. Pitocin 10 units in 1000 ml Normal Saline
    1. Starting rate of 6-12 ml/hour delivers 1-2 mU/minute
    2. Increasing rate 6 ml/hour delivers another 1 mU/min
  2. Pitocin 20 units in 1000 ml Normal Saline
    1. Starting rate of 3-6 ml/hour delivers 1-2 mU/minute
    2. Increasing rate 3 ml/hour delivers another 1 mU/min

V. Protocol: Low Dose

  1. See Monitoring below
  2. Start: 1 mIU/minute
  3. Increase: 1 mU/minute every 15-30 minutes
    1. Base Pitocin rate changes on contractions
    2. After 8 mIU/minute
      1. May then increase by 2 mIU/minute
  4. Maximum: 40 mIU/minute

VI. Protocol: High Dose (nulliparous patients only)

  1. See Monitoring below
  2. Start: 6 mIU/minute
  3. Increase: 1-6 mIU/minute every 20 minutes
  4. Maximum: 40-42 mIU/minute

VII. Monitoring

  1. Intrauterine pressure catheter
    1. Adequate contraction pattern indicators
      1. Montevideo units >50 mmHg per contraction
      2. Montevideo units 200-300 mmHg per 10 minutes
    2. Observe for signs of hyperstimulation
      1. Fetal Distress
      2. Tetanic contractions
  2. Maternal Vital Signs
  3. Continuous Electronic Fetal Monitoring (CEFM)

VIII. Alternative methods

  1. Birth pool as effective as Oxytocin augmentation
    1. Less pain and less use of epidural analgesia
    2. Cluett (2004) BMJ 328:314-8 [PubMed]

IX. Efficacy

  1. Pitocin is preferred in PROM
    1. Oral mifepristone less effective, more side effects
    2. Wing (2005) Am J Obstet Gynecol 192:445-51 [PubMed]
  2. High dose Oxytocin augmentation in nulliparous women
    1. Decrease labor duration by 2 hours without added risk
    2. Merrill (1999) Obstet Gynecol 94:455-63 [PubMed]

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Ontology: Induction of labor procedure (C0259787)

Definition (NCI) The use of pharmacological and/or mechanical methods to initiate labor, including spontaneous rupture of membranes without contractions. Examples of methods include: artificial rupture of membranes, balloons, oxytocin, prostaglandin, laminaria, or other cervical ripening agents. (adapted from reVITALize)(NICHD)
Definition (MSH) Artificially induced UTERINE CONTRACTION. Generally, LABOR, OBSTETRIC is induced with the intent to cause delivery of the fetus and termination of pregnancy.
Definition (CSP) artificially induced uterine contractions intended to cause delivery of the fetus.
Definition (NIC) Initiation or augmentation of labor by mechanical or pharmacological methods
Concepts Therapeutic or Preventive Procedure (T061)
MSH D007751
SnomedCT 236958009
LNC LA20022-2
English Induced Labor, Labor, Induced, induced labor, IND LABOR, LABOR IND, labour induction, labor induction, induction labour, inductions labor, of labor induction, of labour induction, induction labor, induction of labor, induction of labour, Induction of Labor, Labor induction, Labour induction, Induction of labor, Labor Induction, Induction of labour, IOL - Induction of labor, IOL - Induction of labour, Induction of labor (procedure), Labour Induction, Induction of labor procedure
German Einleitung der Wehen, Weheneinleitung, Geburt, eingeleitete, Geburtseinleitung
Italian Induzione di travaglio, Induzione del travaglio
Japanese 分娩誘発, ﾌﾞﾝﾍﾞﾝﾕｳﾊﾂ, 分娩誘発法, 人工分娩, 誘発分娩, 分娩-誘発, 分娩誘起, 陣痛誘発
Swedish Värkarbete, framkallat
Finnish Käynnistetty synnytys
Russian RODY INDUTSIROVANNYE, RODY ISKUSSTVENNYE, РОДЫ ИНДУЦИРОВАННЫЕ, РОДЫ ИСКУССТВЕННЫЕ
Czech Indukce porodu, uměle vyvolávaný porod, vyvolaný porod, porod indukovaný, indukovaný porod
French Accouchement déclenché, Accouchement dirigé, Déclenchement du travail, Accouchement provoqué
Croatian POROĐAJ, INDUCIRANI
Polish Poród wywołany, Poród indukowany
Hungarian Szülés indukció
Norwegian Igangsetting av fødsel, Igangsettelse av fødsel
Spanish Parto Inducido, inducción del trabajo de parto (procedimiento), inducción del trabajo de parto, Inducción del parto, Trabajo de Parto Inducido
Portuguese Parto Induzido, Indução do trabalho de parto, Trabalho de Parto Induzido
Dutch opwekken van weeën, Bevalling, ingeleide, Ingeleide bevalling
Derived from the NIH UMLS (Unified Medical Language System)

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