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External Cephalic Versions, Bishop Scoring, and Labor Induction and Augmentation

Jun 12, 2024

External Cephalic Versions, Bishop Scoring, and Labor Induction and Augmentation

External Cephalic Version (ECV)

  • Definition: A procedure to turn the baby from a breech position (head up, feet down) to a vertex position (head down) from outside the mother's abdomen.
  • Key Concepts:
    • External: Procedure done externally on the mother's abdomen.
    • Cephalic: Pertaining to the baby's head.
    • Version: Refers to rotation or turning.
  • Purpose: Optimal fetal position for labor is head-down (vertex).
  • Risks:
    • Umbilical cord compression
    • Placental abruption
  • When Performed: Around 37 weeks of gestation to avoid preterm labor.
  • Nursing Responsibilities:
    • Continuous monitoring of fetal heart rate and maternal vitals.
    • Post-procedure administration of Rho-GAM to Rh-negative mothers.
    • Administration of IV fluids and tocolytics as ordered.

Bishop Scoring

  • Purpose: Assess maternal readiness for labor induction by evaluating cervical conditions.
  • Components (scored 0-3, except for position and station which are scored 0-2):
    • Cervical consistency
    • Cervical dilation
    • Cervical effacement
    • Cervical position
    • Station of the presenting part
  • Interpretation:
    • Multiparous (had babies before): Score of 8 or higher indicates readiness.
    • Nulliparous (no prior deliveries): Score of 10 or higher indicates readiness.
  • Mnemonic: "I wish my Bishop score would be high enough to induce labor."

Labor Induction and Augmentation

Cervical Ripening

  • Purpose: Prepare the cervix for induction.
  • Methods:
    • Chemical Agents: Prostaglandins like misoprostol (Cytotec).
    • Mechanical Methods:
      • Balloon catheters
      • Cervical dilators
      • Membrane stripping
  • Complications:
    • Uterine tachysystole (hyperstimulation)
    • Risk of uterine rupture
  • Action for Complications: Remove prostaglandins if hyperstimulation occurs.

Amniotomy

  • Definition: Artificial rupture of membranes using a sharp instrument to puncture the amniotic sac, causing the water to break.
  • Risks:
    • Infection
    • Cord prolapse
  • Nursing Responsibilities:
    • Ensure fetal presenting part is engaged before procedure.
    • Monitor fetal heart rate consistently.
    • Check maternal temperature every 2 hours post-procedure to watch for infection.

Oxytocin Administration

  • Purpose: Induce or augment labor; control postpartum bleeding.
  • Effects: Increases the strength, frequency, and length of contractions.
  • Risks: Uterine tachysystole (hyperstimulation)
  • Action for Complications:
    • Discontinue oxytocin if contractions are:
      • More frequent than every 2 minutes
      • Lasting longer than 90 seconds
      • Intensity greater than 90 mm Hg
      • Resting tone greater than 20 mm Hg
    • Administer terbutaline if necessary to reduce uterine activity.

Quiz Questions

  1. Name a complication of an external cephalic version.
  2. What is the Bishop score indicating maternal readiness for labor?
  3. Name a complication of an amniotomy.
  4. Should oxytocin be continued or discontinued if contractions occur every 2.5 minutes, lasting 60 seconds?

Answers:

  1. Umbilical cord compression or placental abruption.
  2. Score of 8 or more for multiparous, 10 or more for nulliparous.
  3. Infection or cord prolapse.
  4. Continue, since contractions are within safe limits.

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