Augmentation Of Labour

Clinical description

Introduction/ Definition Augmentation of labour is accomplished with a variety of interventions that stimulate contractions and accelerate labour. Indications include prolonged labour and arrest disorders.

Contraindications include:

• Abnormal lie and presentation (see Malpresentation)
• Obstructed labour
• Features suggestive of a compromised baby (i.e. fetal distress, IUGR, unexplained oligohydramnios)
• Limb deformities with contracted pelvis
• Previous cesarean section
• Any other contraindications for vaginal delivery

Signs and symptoms

History/Exam/Investigations Protraction or arrest disorders should be well documented on the partograph and/or in the notes prior to labour augmentation.

• Confirm and document fetal wellbeing, presentation, current uterine activity, and EFW prior to beginning

augmentation.

Treatment

Characteristic Management* No previous uterine • Amniotomy surgery • Oxytocin Nulliparous or o Oxytocin 2.5 IU in 1 L NS or RL,starting at 7.5 Multiparous (P4 dpm, then increase to 15 dpm after 30 minutes if and below) tolerated and still no strong contractions, and then titrating up to by 15 dpm every 30 minutes until 3 strong contractions every 10 minutes, to maximum dose of 60 dpm (see section on Oxytocin Infusion Rate)

• Monitor woman and fetus closely

Grandmultiparous • Amniotomy (P5 and above) • Oxytocin only if Consultant agrees HIV-infected • No difference in management of augmentation if obstetrically indicated

• Delay amniotomy

*Use oxytocin with caution due to risk of uterine rupture; see section on Oxytocin Infusion Rate Reassess the cervical dilation after 4 hrs of at least 3 strong contractions every 10 minutes to see if labour has progressed satisfactorily.

If labour has not progressed, then consider amniotomy if not already performed or caesarean delivery.

Consider continuing oxytocin while awaiting OT if there are no signs of fetal distress.