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    Augmentation of Labour: Nabhan A, Boulvain M

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    Made Surya
    This document summarizes the practice of augmenting labor through methods like artificial rupture of membranes (amniotomy) and oxytocin administration. It discusses how to assess labor progress and the diagnosis of active labor. For augmentation, amniotomy alone can often speed up contractions, while amniotomy followed by low-dose oxytocin infusion can shorten the first stage of labor without improving other outcomes. Oxytocin administration requires careful dosing as overdosage can cause complications while suboptimal dosing may lead to unnecessary C-sections. Protocols for oxytocin augmentation vary in initial dose, increment size, and maximum dose.

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    Augmentation of Labour: Nabhan A, Boulvain M

    Uploaded by

    Made Surya
    139 views8 pages
    This document summarizes the practice of augmenting labor through methods like artificial rupture of membranes (amniotomy) and oxytocin administration. It discusses how to assess labor progress and the diagnosis of active labor. For augmentation, amniotomy alone can often speed up contractions, while amniotomy followed by low-dose oxytocin infusion can shorten the first stage of labor without improving other outcomes. Oxytocin administration requires careful dosing as overdosage can cause complications while suboptimal dosing may lead to unnecessary C-sections. Protocols for oxytocin augmentation vary in initial dose, increment size, and maximum dose.

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    AUGMENTATION OF LABOUR

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    This document summarizes the practice of augmenting labor through methods like artificial rupture of membranes (amniotomy) and oxytocin administration. It discusses how to assess labor progress and the diagnosis of active labor. For augmentation, amniotomy alone can often speed up contractions, while amniotomy followed by low-dose oxytocin infusion can shorten the first stage of labor without improving other outcomes. Oxytocin administration requires careful dosing as overdosage can cause complications while suboptimal dosing may lead to unnecessary C-sections. Protocols for oxytocin augmentation vary in initial dose, increment size, and maximum dose.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    139 views8 pages

    Augmentation of Labour: Nabhan A, Boulvain M

    Uploaded by

    Made Surya
    This document summarizes the practice of augmenting labor through methods like artificial rupture of membranes (amniotomy) and oxytocin administration. It discusses how to assess labor progress and the diagnosis of active labor. For augmentation, amniotomy alone can often speed up contractions, while amniotomy followed by low-dose oxytocin infusion can shorten the first stage of labor without improving other outcomes. Oxytocin administration requires careful dosing as overdosage can cause complications while suboptimal dosing may lead to unnecessary C-sections. Protocols for oxytocin augmentation vary in initial dose, increment size, and maximum dose.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 8

    AUGMENTATION OF

    LABOUR
    Nabhan A, Boulvain M
    Introduction
    • Augmentation, from Latin augere “to increase”, of labour is a practice
    that aims at increasing the frequency, duration and intensity of uterine
    contractions
    • This may be performed after a spontaneous onset of labour or after
    induction of labour
    • Oxytocin for the purposes of augmentation and induction of labour is
    one of the most frequently used medications in obstetrics
    Diagnosis and Assessment of Labour
    Progress
    • The diagnosis of active labour depends on careful assessment of
    regular uterine contractions with progressive cervical effacement and
    dilatation
    • In average, multiparous labour is shorter than in primiparous women,
    once regular contractions are established
    • Progress in labour is assessed by clinical vaginal examination and
    recorded on a standard labour graph (a partogram)
    How to Augment Labour
    • Amniotomy / artificial rupture of membranes (AROM)
    • rupture of intact membranes itself will often augment uterine contractions, therefore
    preventing, or treating, delay in the first stage of labour
    • allows to inspect the nature of the liquor, especially in high-risk cases or if the foetal heart
    rate (FHR) pattern is abnormal
    • Amniotomy vs expectant management
    • amniotomy, as compared to expectant management, reduces the duration of the first stage
    • in nulliparous women, amniotomy significantly reduced the time to birth
    • no evidence of differences in any other maternal outcome: use of oxytocin; use of
    analgesia; caesarean section; instrumental birth; maternal febrile morbidity; maternal
    blood transfusion or maternal satisfaction; incidence of abnormal or non-reassuring FHR;
    rotation of the foetal head; Apgar score less than 7 at 5 min; neonatal jaundice; admission
    to special care nursery; cephalhaematoma and neonatal infectious morbidity
    How to Augment Labour
    • Amniotomy and oxytocin vs oxytocin
    • no evidence of a difference in the interval between randomization and birth; caesarean section
    and neonatal infection, although there was significantly more women with postpartum
    infection in women in the amniotomy group
    • Amniotomy vs amniotomy plus oxytocin
    • no evidence of differences in the rate of caesarean section; use of epidural; proportion of the
    babies with an Apgar score less than 7 at 5 min; admissions to the neonatal unit and maternal
    satisfaction score
    • Amniotomy and oxytocin vs delayed amniotomy and oxytocin
    • there is evidence that, when progress of labour is slow, amniotomy followed by an oxytocin
    infusion with a low-dose regimen (0e3 mU per minute) shortens the duration of the first stage
    of labour, but it does not appear to improve the probability of vaginal birth or any other
    outcome
    Oxytocin Administration
    • Oxytocin receptors in the uterus increase during pregnancy and labour
    • Uterus becomes more sensitive to small doses of administered
    oxytocin
    • Intravenous oxytocin should be administered using a peristaltic
    infusion pump
    • Overdosage may lead to uterine hyperstimulation (lead to foetal
    hypoxia and uterine rupture), while a suboptimal dose may lead to a
    false diagnosis of failure to progress and caesarean section
    Oxytocin Administration
    • Protocols for oxytocin administration vary in:
    • the initial dose (1-7 mU/min)
    • the interval for increasing the dose (15-40 min)
    • the increment (2-4 mU/min)
    • the maximum dose (20-40 mU/min)
    Reference
    • Nabhan A, Boulvain M. Augmentation of labour. Best Pract Res Clin
    Obstet Gynaecol. 2020 Aug;67:80-89

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