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Monitoring
- It is recommended that facilities for continuous uterine and fetal heart rate (HR) monitoring are available during labor induction
- Continuous uterine activity and fetal HR monitoring is recommended if Prostaglandin E2 (PGE2) or Oxytocin is to be administered
- Maternal pulse, blood pressure (BP), uterine contractions and fetal heart tone should be assessed and documented
- Reassess Bishop score (after 6 hours for vaginal tablet or gel for 24 hours for controlled-release pessary)
- Uterine tachysystole
- Monitor for uterine tachysystole and institute appropriate management if it occurs
- Patients should never be left unattended while Oxytocin is being administered
- Appropriate measures if uterine tachysystole occurs
- Discontinue Oxytocin or remove any remaining Prostaglandin preparation (do not irrigate cervix/vagina) and apply supportive/resuscitative measures if:
- Uterine contractions exceed 5 in a 10-minute period (tachysystole) or
- Uterine contractions last longer than 90-120 seconds
- Fetal HR decelerates significantly; non-reassuring fetal heart rate tracing
- For persistence of excessive uterine activity, begin tocolysis with
- Terbutaline 250 mcg subcutaneous/intravenous (SC/IV) or
- Glyceryl trinitrate 50-200 mcg IV or 1-2 sublingual spray (400-800 mcg) is recommended
- Place patient in the lateral position, oxygen (O2) by face mask may be administered
- Oxytocin may be restarted at 1/2 the dose if resuscitation is successful
- Discontinue Oxytocin or remove any remaining Prostaglandin preparation (do not irrigate cervix/vagina) and apply supportive/resuscitative measures if:
- Pain relief during induction of labor
- Patients should be informed of the possibility of induced labor being more painful than spontaneous labor
- Pain relief should be offered depending on what is appropriate for the patient and her pain
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