1. Roseann is scheduled for augmentation of labor with oxytocin.

What factors would

you ensure are in place before augmentation is begun?

Augmentation of labor is the practice of increasing the frequency, duration, and intensity
of uterine contractions after the commencement of labor, either through intravenous oxytocin
infusion or artificial membrane rupture, and is used to treat prolonged labor and perhaps avoid
cesarean section (CS). Prior to beginning oxytocin labor, formal counseling, agreement, and
documentation from Roseanne, including awareness of urine hyperstimulation complications,
should be acquired. Also, make sure that the following parameters are met: the fetus is in a long
position.

à The uterus is ready for delivery or also known as “ripe”.

à Part of presentation is engaged. There is no CPD.
à A fetus is considered mature at the date indicated by the lecithin-sphingomyelin
ratio or biparietal diameter on ultrasound to rule out preterm birth.
à Fetal Assessment and Maternal Assessment
à Provider notification parameters and standing orders for response to complications

2. The baby of Mrs. P is in occipito-posterior position. She is experiencing severe back

pain. What actions could her husband take to help relieve his wife’s pain caused by this
posterior fetal position?

Occipito-posterior position is the most common fetal malposition and mostly induced by
the head's adaptation to a pelvis with a narrow fore pelvis and a large anteroposterior diameter,
and may thus be termed "physiologic." Many pregnant women have back pain as their stomachs
expand and their muscles and spine struggle to support the added weight. The location of the baby
inside the womb may also be a source of discomfort. The following ways to help ease her wife’s
back pain are:

à Sit in ergonomic chairs with supportive backs or put a small pillow at the small of
your back and try to sit up straight.
 à Encourage her to exercise that will strengthen muscles and increases her flexibility.
It can also relieve stress on the spine. Safe exercises that are applicable for pregnant
women include walking, swimming, and stationary cycling. Ask the doctor for the
recommended exercises and stretching to help with the back pain.
à Applying cold compress on her back. If the doctor agrees, start applying warm
compress or place a heating pad on the painful area. Be careful not to heat the belly
during pregnancy.
à Get a gently pregnancy massage if the doctor agrees.
à Do not take any medications without doctor’s prescription.
à Avoid lifting anything that weighs more than a few pounds.
à Sleeping on your side with at least one knee bent will also help improve back pain.
You can try using a pregnancy pillow to make sleeping comfortable.
à Wearing an abdominal support or maternity pants can also help in back pain.
à Get a firm mattress or put a board between your mattress and box spring to support
your back during sleep.

3. After rupture of the mother’s membranes, the fetal monitor shows variable
decelerations. On inspection, you are able to see the umbilical cord at the vaginal
opening. You are aware that this is a fetal emergency. In order of priority, what would
be your best actions?

Cord prolapse occurs in the presence of ruptured membranes, and it is either occult or overt:
à Occult (incomplete) cord prolapse – the umbilical cord descends alongside the
presenting part, but not beyond it.
à Overt (complete) cord prolapse – the umbilical cord descends past the
presenting part and is lower than the presenting part in the pelvis.
à Cord presentation – the presence of the umbilical cord between the presenting
part and the cervix. This can occur with or without intact membranes.

The following are the best actions or management:

à Continuous fetal monitoring
 à Inform anesthetist, pediatrician, and OR staff.
à Avoid handling the cord to reduce vasospasm.
à Manually elevate the presenting part by lifting the presenting part off the cord
by vaginal digital examination.
à Consider tocolysis (e.g. terbutaline)
à Not a first line management – can be consider if prolonged interval to delivery
is expected.
à Keep the cord moist.
à Delivery is usually via emergency Caesarean Section.

Resources:
http://apps.who.int/iris/bitstream/handle/10665/174001/WHO_RHR_15.05_eng.pdf;js
essionid=16B03AE075BD3C0E248F2253EE77EB0D?sequence=1
https://kidshealth.org/en/parents/achy-back.html
https://www.ahrq.gov/hai/tools/perinatal-care/modules/strategies/medication/tool-
safe-oxytocin.html
https://teachmeobgyn.com/labour/emergencies/cord-prolapse/