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What is Oxytocin‑induced or Oxytocin‑augmented Labor:Nursing Case Study

Monday, 31 March 2014


The female hormone oxytocin is produced by the posterior pituitary gland and stimulates uterine contractions. This oxytocic effect is greatest at term. However, oxytocin infusion, which acts similarly to the naturally occurring hormone, may be used in antenatal situations where labor must either be induced to start or must be assisted by increasing the force of uterine contractions. Augmentation of labor is initiated in the active phase of the first stage of labor or in the second stage when labor is failing to progress adequately, placing the fetus and mother at risk. Several conditions can dictate the need for labor to be induced at term or earlier depending on the ability of the fetus to survive extrauterine life. These include gestational age greater than 42 weeks, maternal history of precipitate labor in a multiparous patient, polyhydramnios or hydramnios, Rh isoimmunization, severe preeclampsia near or at term, prolonged premature rupture of membranes, diabetes, abruptio placentae, incomplete or inevitable abortion, and fetal death. The goal of treatment is to stimulate labor as similar to natural labor as possible while ensuring maternal and fetal well‑being and preventing complications associated with oxytocin induction.

Pathophysiology
Oxytocin indirectly stimulates contraction of the uterine smooth muscle by increasing sodium permeability of uterine myofibrils. The threshold for response is lowered when estrogen levels are high. Uterine response increases with the length of pregnancy and active labor. The response mimics labor contractions.

Complications
■ Hyperstimulation syndrome
■ Uterine rupture (particularly with previous uterine scar)
■ Fetal distress

Assessment
Health perception and management
■ Fear

Elimination
■ Urinary frequency
■ Constipation

Cognition and perception
■ Anxiety

Roles and relationships
■ Unhealthy family dynamics

Coping and stress management
■ Stress level

Physical examination
Mental status and behavior
■ Anxiety
■ Fear

Cardiovascular
■ Increased cardiac demand
■ Increased blood pressure

Reproductive
■ Possible hypotonic uterine contractions

Diagnostic Tests
■ Contraction stress test assesses fetal well-being.
■ Pelvic or uterine ultrasonography assesses gestational age and size and the position of the fetus.
■ Lecithin-to-sphingomyelin ratio assesses fetal lung maturity, except in cases of maternal diabetes, Rh incompatibility, or fetal asphyxia.
■ Bishop score is a five-parameter scoring system that estimates the success of induction. The maximum score is 13. The minimum score for induction without the use of a cervical ripening agent is 6.

Teaching checklist
■ Reason for induction
■ Oxytocin use
■ Induction process
■ Importance of concentrating on fetal movements or kick counts
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