GENERAL MANAGEMENT OF INEFFECTIVE LABOR

Our next topic is the general management of ineffective labor. So again, if we talk about ineffective labor, we are referring to the hypotonic, hypertonic conditions, or hypertonic or hypotonic uterine contractions; uncoordinated uterine contractions that lead to prolonged labor, either during the first stage or second stage of labor. So last time, we will [Musika] almost—so most of the time, um, most of the time this uh, this management in patients with prolonged labor and also the ineffective uterine contraction focuses on the uh, making the cervix ripen, or dapat magkaroon ng effacement. Then kailangan magbigay tayo ng augmentation or induction. Then so pagusapan natin yon. Number one na ginagawa natin as general intervention for ineffective labor para masis ang process of labor, a tinatawag nating cervical ring.

Cervical ring, of course, cervical ring is done in cases—if in case that the cervix is not yet effaced or not yet ripe. So ibig sabihin, uh, we have to change the consistency of the cervix from firm to soft. Okay, change consistency, change consistency from firm to soft, from firm to soft. And this is commonly done as the first step, to the first step, to complete in early labor. Take note that labor will not proceed if the cervix is not yet ripe, or wala pa tayong tinatawag na cervical effacement. Clear now? There are cervical criteria; there are cervical criteria na ginagawa natin for scoring, scoring if the cervix is ready for um, ripening or yung tinatawag nating elective induction. Okay, sa criteria for scoring for elective induction, ibig sabihin, there is a score that we have to—to meet before we use your uh, manual method of ripening the cervix. Take note that the cervix will ripen even without the interventions of a health worker. So kusang siyang nag-ripen, kusang siyang umi-ripen, kusang siyang nag-efface at the end of the process. However, in some cases, hindi nangyayari iyon. There are criteria that we need to follow before we do the manual ripening of the cervix. Pag-usapan natin yon.

First criteria is dilation. So this one, we are referring to dilation of your—what cervix natin? 0, 1, 2, 3. Anong points natin siya? 0, 1, 2, 3. 0 cm, ang score niya is 0; ibig sabihin, no cervical dilation. Ang score niya is zero. 1 to 2 cm, score is 1. 3 to 4 cm, score is 2. 3 to 4 cm and above, score niya is 3. 3 tayo? Yes. Number two, what is the next criteria? Effacement. Ito ba yung cervical thinning? Yes, cervical thinning. Kag ang cervical thinning is 0 to 30%, kasi pine-percentage natin ito. Ito naman, 40 to 50%. And this one is 60 to 70%. Then over 80% naman is 3. Station—naalala niyo pa kung paano stationing? So kapag sinabing within the pelvic inlet, the station is negative. Outside or passed through the ischial spine, anong tawag doon? Positive stationing. At the level of the ischial spine is zero. So for example, if this is your ischial spine, this is the pelvic inlet, that’s -1, -2, -3. Then this is your zero station, zero. Then we have 1, 2, 3. So yung 2 and 3, yan na po yung crowning. Am I right? Yes. Yung nakikita mo na yung ulo niya sa kanyang vagina mismo. Okay, now stationing natin. Kapag -3, -2, -1 to 0 is still positive. 1 and 2 is 3, positive. 1 and 2 is three. Number four criteria, consistency. Consistency. Ang consistency is firm. Firm. Ano yung firm? Tip of the nose niyo. To kung nandito kayo sa akin ng in-enc last semester, ulo ko yan. Tip of the nose. You try to pick a tip of the nose; that is the normal consistency of cervix na hindi pa ripen. Pero pag ripen na, your ear lobe. Okay, your ear lobe. So firm, next, medium, medium, near soft. Okay, medium, soft, more than that, the softest siguro. Okay, malamang. And number five, okay, position. Kailangan iconsider din natin position. Posterior. Nalala niyo posterior? Kapag sinabing posterior, batok ang mauna. Pwede ba yon? Naka-flex yung ulo ng baby? Hindi pwede. Am I right? Yes. Mid position, mid position, then anterior, anterior. So that is your score ngayon according sa ating pelvic examination chart. Kapag ang cervix daw scores more than 8, okay, if the criteria—okay, note: a score of more than 8, proceed with induction. Kapag ang score niya is more than 8, proceed with induction, proceed with induction. Pag lagpas ng 8 ang kanyang score, maliwanag po tayo? Yes. Okay. Now, what are the steps, sir, or method of cervical ripening? The method of cervical ripening. Number one, stripping membrane. Stripping, as in stripping. Ito ba yung ginagawa mo? Oo, kaso nahagisan ka ng pera-pera. Sleeping membrane. Ano naman ang sleeping membrane? Separating. So this is separating, separating the membranes, separating the membranes from the lower segment, from the lower—separating the membrane from the lower uterine segment, separating the membrane from the lower uterine segment, through internal examination. Parang—ano gagawin mo sa kanya? Ie-examine mo. Okay, then ipu-push mo slightly yung uterus para yung membrane sa uterus mag-separate. Complication yan. Possible complication. So what are the possible complications? Pwede bang magdugo? Yes, especially kapag meron tayong placenta previa. Possible complication is bleeding from [Musika] undetected placenta previa, bleeding from undetected placenta previa. Number two, rupture of membranes, of course, unintentional, unintentional rupture of membranes. Akala mo kasi cervix yun pala bigla siyang—yun pala, kapag nagpasok sa cervix, natusok mo yung amniotic sac, so pumutok. Okay, so rupture of the amniotic membranes. Number three, infection. So pag pumutok siya, rupture, pag pumutok si membrane, possible na bang maging brad for infection? Yes, risk for infection ng ating pasyente.

Okay, number two, use of hygroscopic suppositories. Pag sinabing suppositories, alam niyo naman na ito is—it’s medications that will be placed in the vagina or the rectum, basta directly na pinapasok on that particular area. So ano naman po ang hygroscopic suppositories? Hydro—that’s r s—hygroscopic suppositories. So hygroscopic suppositories is use of seaweed. Yes, the use of—that’s well—the use of seaweed—that’s well—on contact with cervical secretions. So parang seaweed na kinakain niyo, but this one, it’s dry talaga, parang ganon din, dry seaweed. So the dry seaweed is—without—so gagawin non, the moisture will absorb the moisture, which is the secretions. So kapag ginawa natin yon, ano ang gagawin natin doon? Ano ang mangyayari? Magkakaroon siya ng—what it leads into? Gradual—it leads into gradual and gentle or gently urge to dilate, gradual and gently urge to dilatation, urge to dilatation, gently urge dilatation. Okay, next, pag sinabi natin use of hygroscopic suppositories, it is placed—rock with God—it is placed—rock with GS—rock r r w r a t w. Balot, nabalut yung seaweed, babalutin ng—yan na ang inyong boss—saturated with povidone-iodine or antifungal cream, or antifungal cream. Question, sir, bakit kailangan ng povidone-iodine or antifungal cream? Pwede bang ikaw ang nag-introduce ng infection? Yes, kasi yung dried seaweeds na iyon, or that seaweed was actually—what—possible na na mag-collect ng bacterias or even fungi. Pag naglagay ng fungi sa pep, pwde magdevelop ng candidiasis. Kapag naman povidone-iodine, okay, mga bacteria, kailangan nilagay mo ito to protect, okay, as a—as a—as a form of antiseptic solution. Okay, as a form of antiseptic solution. Document, document mo dapat yung sponges and dilators placed. Nakakita na kayo ng dilator? Ang dilator, ginagamit natin ito lalo na sa mga pasyente na possible magkaroon ng shrinking or hypopyon sa mga procedures like radiation. Ang mga babae na nag-undergo ng radiation therapy, pwede magkaroon ng vaginal atrophy; ibig sabihin, magiging masikip yung kanilang vagina. So magiging masikip na, tendency ang hirap na rin—of course, it would affect sexual intercourse. So for that not to happen after the procedure, gumagamit sila ng different sizes of dilators. So ang ginagawa nila, mag-start sila with the smallest or thinnest, then habang tumatagal, pinapakapal ng pinapakapal ng pinapakapal until bumalik na yung stability nung vagina. Okay, ginagamit yan. Pag-alala niyo yan pagdating niyo sa medical surgical nursing, onco, or cancer nursing. Okay, kapag ang pasyente nag-undergo ng radiation therapy. Okay, pag-alala niyo po yan. Okay, so that is your use of hygroscopic suppositories. Okay, ito naman yung pinaka-common. Number three, this is the most common na ginagamit, the use of prostaglandin gel. Pag sinabing use of prostaglandin gel, anong example nito? Misoprostol, or commonly, or—lem—lem—cy—anan—misoprostol or your cytotec. So this is the most common method, this is the most common method na ginagamit for cervical ripening. Okay, most common method for cervical ripening. So ina-apply siya 2 to 3 times with 6-hour interval. Ginagawa siya 2 to 3 times with 6-hour interval. Okay, so during this procedure, you have to position patient in side-lying, sir. Bakit kailangan naka-side-lying ang pasyente? This is a gel, parang lubricant. So pag hindi mo siya sinide-lying at naka-position lang siya, magle-leak out. So yung nasa loob na gamot, ilalabas lang din. Okay, so imagine parang naglalaway si Kit, naglalaway siya ng prostaglandin gel, and dapat yung prostaglandin gel na iyon nasa loob lang. Okay, so dapat position the patient on side-lying position. Then after that, monitor for—so ano ba yung goal natin dito? Mag-open ang cervix, mag-efface na siya. So possible ba na magkaroon ng adverse effects or reactions? Yes, baka biglaan ang pagbukas, pwedeng magkaroon ng—what—problems with the fetus. Kaya monitor for FHR, okay, at least 30 minutes, at least 30 minutes every after application, every after application, monitor for 30 minutes every after application. Are we clear? Maliwanag po? Yes. Tapos na tayo sa cervical ripening. Punta naman tayo sa number two, induction of labor. Pag sinabing induction of labor, initiates contraction. Ibig sabihin, ang induction of labor is that hindi pa siya nag-labor pero dapat na or kailangan na siyang manganak because of certain complications. So ang gagawin natin, i-trigger by inducting the labor. Iba po siya sa augmentation. Augmentation, patient is already in labor, para mas mabibilis lang ang labor. Nagbibigay tayo ng mga—mga—how to faster the labor. Induction of labor, wala pang labor na nangyayari. So anong gagawin natin? Manually or artificially, we would start the labor process. Yun po ang ibig sabihin ng induction of labor. So basically, you’re going to initiate contraction sa mga pasyente na on full-term mother. Kailangan po full term na? Yes. You do not induce labor kapag ang baby is preterm, at least ideally, unless there is a possible complication that makes you use induction of labor. Okay, so paano tayo nag-i-induce ng labor? Induction of labor starts 6 to 12 hours after prostaglandin gel [Musika] application. Meaning, do we need to ripen the cervix before we induce labor? Yes, because without ripening the cervix, magkakaroon ba ng cervical dilatation? No. Kaya magkakaroon ng prolonged labor. Ang prolonged labor is complication na rin. Yes. Okay, it’s already a complication. So how we going to do this? Administer, administer oxytocin. Administer oxytocin intravenously, administer oxytocin intravenously. Okay, sir, ano ang rationale kung bakit IV natin to binibigay? Okay, oxytocin, pag-aralan natin ito. Oxytocin, or commonly known as Pitocin, is a uterotonic. Ibig sabihin, it promotes uterine contraction. Ang half-life—pag sinabing half-life, the medication starts to wear off. Ibig sabihin, pag na-receive niya na ang peak, kasunod na nun is half-life. Naalala niyo ba yon? Okay, basic pharmacology. ‘Pag nagbigay ka ng gamot, meron yung initial effect, then magu-una tayo sa peak effect. Then after ng half-life, ibig sabihin ng half-life, after ng peak, yung gamot starts na siyang magbababa ang effect. Half-life. Ang half-life po ng oxytocin is just 3 minutes. Ibig sabihin, once you give oxytocin, spike agad yan. Then after giving at initial dose, depende kung gaano karami, magda-dalawang [Musika] kasi the level of insulin is also going down instantly. Mabilis ang epekto, mabilis siya naconsume at the same time mabilis din mauubos. So pag ini-stop mo agad ang insulin administration, stop na rin ang pagtaas ng level ng insulin, stop na rin ang effect niya, which is your uterine contraction. Kailan mo ginagawa yung—sir, if there is possible hyperstimulation? Ulitin natin. We are giving IV administration of oxytocin for one reason: number one, to discontinue it immediately, to discontinue it immediately if hyperstimulation occurs, to discontinue it immediately if hyperstimulation occurs. Ibig sabihin, pag naroroon tayo ng hyperstimulation, stop mo na agad kasi pag ini-stop mo, baba agad ang insulin level, mawawala agad ang effect kasi ang kanyang half-life is only 3 minutes. So whatever thing na ininject mo sa katawan, ubos yan or maubos yan in a period of 3 minutes onwards. Na clear? Are we clear? Yes. Very important po yan na alam niyo kasi nga okay. Ang oxytocin is a common medication sa inyong practice now. Pag sinabing oxytocin, as I’ve mentioned, approximately 3 minutes ang kanyang half-life. It is done through piggyback, piggyback. Pag sinabing piggyback, mga kapatid, piggyback with our Ringer’s solution. Piggyback with Ringer’s solution. Ano pong ibig sabihin niyan? Okay, piggyback with Ringer’s solution, i-i-incorporate po natin sa LRS. Okay tayo? Yes. Okay, so what is the regular [Musika] infusion? Regular infusion natin? Regular infusion is 0.5 to 1 unit per minute, 0.5 to 1 unit per [Musika] minute. Then gradually increase in unit—inter—[Musika] 15, 15 with interval of 15 to 60 minutes. Ulitin po natin yan. Okay, so ang initial dose po natin is 0.5 to 1 unit per minute, then gradually increase about 1 to 2 units with interval of 15 to 60, okay, with interval of 15 to 60. Now, after 15 minutes, kapag hindi pa ganon kataas ang contraction, then you can give another dose in 15 minutes. Yun po ang ibig sabihin nun. But if the contraction is enough, then you can make the interval 60 minutes. Okay, this is to prevent hyperstimulation. Then at 4 cm, very important po ito, at 4 cm, artificial, at 4 cm, artificial rupture of membrane, artificial ROM is performed. Ibig sabihin, kapag ang cervix is 4 cm, ROM na po tayo. Ano? ROM. And stop infusion, stop infusion. You may now discontinue the infusion. Okay, next, side [Musika] effects. Makinig maigi sa side effects because this side effect is not only sa ating induction of labor but is also sa augmentation of labor. Ibig sabihin, basta gumagamit ka ng oxytocin, possible complication ng mga ito kaya dapat mong i-assess. This is also one of the main reasons kung bakit hindi advisable na magbigay ng oxytocin prior to the delivery of the fetus. Kaya kailan ba binibigay yung oxytocin natin? On the third stage of labor. Ay, set? Ah, third stage of labor, which is your placental stage. ‘To ba? Yes. When the—when the baby is already out, magbibigay ka ng 10 units. Tama mo ba? Yes. Yun dapat ang original na pagbibigay lang. Ideally, dapat hindi siya binibigay prior unless there is a problem with the labor process. Pero kung gusto madaliin, pwede mo siyang ibigay as augmentation; however, it is—what—not advisable because of this following complication. Ano mga complication na yan, sir? Number one, hypertonic contraction. So pwede tayong magkaroon ng hypertonic contraction. Pag sinabing hypertonic contraction, it can lead to hyperstimulation. So hypertonic contraction is due to hyperstimulation related to prolonged oxytocin use, hyperstimulation related to prolonged oxytocin use. So pag sinabing hyperstimulation, hypercontraction, nagco-constrict ang kanyang—compress ba? So hypertonic contraction, it compresses the uterus kasi contracted, contracted uterus. What will happen to the blood vessels inside? Constricted, iniipit. In that case, ma-cut si baby ng oxygen. Hindi nakukuha ni baby ang oxygen. What will—may lead to fetal death. Tama mo ba? Yes, can lead to fetal death. And take note, hyperstimulation due to—okay—prolonged use of oxytocin can also lead to uterine rupture. Pwede pong mapunit si uterus. Pwede pong mapunit si uterus. Now, what is the management? Management natin kapag nagkaroon ng hypertonic contractions? Anong gusto natin? I-relax or i-stimulate uterus? I-relax. Magbibigay tayo ng beta-adrenergic, beta, beta-adrenergic receptor drug. Ano mga example ng beta receptor drugs? Letter T. Terbutaline and magnesium sulfate, and magnesium sulfate. So terbutaline and magnesium sulfate, terbutaline and magnesium sulfate. Ano effect ng mga gamot na ito? It decreases, decreases myometrial activity. Ilagay mo diyan, it decreases myometrial activity. It decreases the myometrial activity. Ulitin natin. Possible complication ng induction of labor due to use of oxytocin? Pwede mo magkaroon ng hyperstimulation. Yes. Yang hyperstimulation na yan, pwede mo maglead dito sa hypertonic contraction. Yes. Anong gagawin niyo sa blood vessels? Constrict or relax? Constrict. Mababawasan ba ang oxygen delivery sa fetus? Yes. Magli-lead to fetal death? Yes. Tama mo ba? Yes. Then pwede mo magkaroon ng uterine rupture. Yes, because of the strong compression. Okay, pwedeng bumigay yung kanilang myometrium. Okay, para ibaba ang contractility ng inyong matris, magbibigay tayo ng beta-adrenergic receptor drug. What are those? Terbutaline and magnesium sulfate. Anong effect? Decrease activity. So again, that is just one of the complications ng prolonged use of oxytocin or pag sumobra. Number two, number two, ilagay mo po diyan [Musika] hypotension, sir. Bakit naman po hypotension, sir? Hypotension plus tachycardia, hypotension plus tachycardia. So hypotension occurs due to—due to peripheral vessel [Musika] vasodilation, due to peripheral vessel vasodilation, peripheral vessel—pag sinabing vessel, alam mo yan, ugat. Peripheral means distant from the body, extremities. So dito mo ba kinukuha blood pressure mo? Yes. And take note—ano nangyari daw? Dilated. So lumuluwang ang daanan ng dugo. Pag lumuwang ang daanan ng dugo periphery, hindi sa uterine na periphery, periphery. Pag lumuwang, kamusta ang pressure? Mataas? Mababa? Imagine na hose na malakas ang tubig pero maliit ang butas, sumisirit po ba? Yes. Ganun din po rito. Pag malawak ang daanan, hindi sisirit ang tubig or hindi sisirit ang dugo; therefore, pressure is low, leading into hypotension. Okay, take note, body compensates. Lagi kong sinasabi sa inyo, to—lahat yata ng na-discuss ko na lagi kong isinisingit to—pag may hypotension, body will try to adopt to compensate. One of the compensatory mechanisms is the heart will pump more blood; kaya meron tayong tachycardia. Tayo? Yes. Anong cause ng tachycardia? Because of your hypotension. Are we clear? So anong gagawin natin? Monitor BP every 15 minutes pag nagbibigay tayo ng oxytocin. Ginagawa mo ba yan? Yes. Post surgery or post delivery, nag-monitor ka ba ng every 15 minutes? Yes, per hour. Kasi nga paunti-unti ang effect. Oxytocin. Alam niyo pa ba kung bakit niyo ginagawa yon? After, during labor and after labor. Yes. Okay, ano pa, sir? Ano pa? Ay, by the way, kapag may hypotension, ha? Management natin to. Management: monitor BP, okay, every 15 minutes, every 15 minutes. Ano pa? Monitor uterine [Musika] contractions. So paano na-monitor ang uterine contraction, sir? Depende kung nasa—kung nasang stage ka na ng labor. Nala niyo kanina? PH 30 to 45. Tama po ba? 30 to 45 with 3 to 5 minutes interval, contractions, yon seconds per contraction. Okay, then kapag po ang contraction natin sa active phase, mas mahaba po ba? Yes, 40 to 60 seconds per contraction for 3 to 5 minutes interval. Okay, pag mas mahaba na doon or mas maiksi, kailangan tine-take note mo yon. So kailangan po ba naka-connect dito, naka-CTG? Yes, CTG. And you also need to monitor the FHR to monitor for signs of fetal distress, monitor for signs of fetal distress. Number three, ito na nito, decrease urine output. Pag sinabi naman nating decrease urine output, due to antidiuretic effect of oxytocin. Ibig sabihin pala sir, pag nagte-take ako ng oxytocin, meron akong antidiuretic effect. Hindi ako iihi. Yes. Ibig sabihin, meron kang urinary frequency or urinary [Musika] retention. Ang pasyente nag-take ng oxytocin, oxytocin has antidiuretic effect. Antidiuretic. Diuretic: ihi. Anti: wag, wag iihi. For ihi mo mababa or anuria, kung wala kang ihi. Question: anong meron tayo? Urinary frequency or urinary uh—retention. Retention. So meron tayong urinary retention. Naiipon ang tubig sa katawan. Tama mo ba? Yes. Dahil naiipon ang tubig sa katawan, it leads into water intoxication. So narinig niyo na ang water intoxication? Na ang normal tubig natin sa isang araw, 6 to 8 glasses. If you go more than that, hindi ka naman masyadong pinagpapawisan, wala ka namang source of dehydration, pwede kang magkaroon ng water intoxication. Ibig sabihin, dumami ang tubig ng katawan. Kung dumami ang tubig ng katawan, kamusta ang electrolytes or osmolarity? Taas? Baba? Kaya kasi ko yung videos, sinasabi ko yung videos ko—ba ng—cru—insulin. Ayan, h’wag niyo lang binalewala kasi nga may kinalaman na naman dito. Ulitin ko po, water intoxication. Dumami or kumonti ang tubig ng katawan? Dumami. Dahil dumami ang tubig ng katawan, what will happen to the osmolarity of the blood? Increases or decreases? Decreases. Nagkakaroon tayo ng decreased osmolarity. Bakit? Because osmolarity is the concentration of solutes or electrolytes in the blood. Eh dumami ang tubig kasi hindi nilalabas ng katawan. Anong mangyayari? Dilute. So magkakaroon tayo ng hyponatremia, hypokalemia. Delikado bang mga bagay na ito? Yes. Okay, signs of toxicity. Okay, signs of toxicity, signs and symptoms of toxicity, signs and symptoms of toxicity. Okay, i-check mo, baka meron siyang nausea and vomiting, baka meron siyang nausea and vomiting. What else? Seizure. What else? Coma. Then of course, i-monitor mo yung death. Okay, we’ll lead into that. ‘To pa? Yes. This is ju—due to [Musika] interstitial shift of fluids, due to interstitial shift of fluids, due to interstitial shift of fluids. So pwede tayong magkaroon ng fluid and electrolyte imbalance. In this case, meron tayong hypo condition due to water intoxication. Common symptoms: ito yung hyper—hyponatremia. Ibig sabihin, kokonti ang sodium ng dugo kasi lumabnaw ang dugo dahil sa dami ng tubig. Kaya yung shifting ng fluid, tumaas ang sodium sa interstitial space and other space, yung fluid nag-move doon, papunta doon kung saan mataas ang solute. Delikado po ba ito? Yes, it can—only to—death. Kaya nga you monitor for—nausea and vomiting. Ang nausea and vomiting is an initial, initial, initial symptom for water intoxication when you are taking oxytocin. Tayo? Yes. Okay, when you’re taking. So ano yung management natin dito? What is your management? What is your management? Monitor urine output, specific urine output, okay, and [Musika] specific gravity. Specific gravity. So kapag meron tayong water intoxication, anong mangyayari sa specific gravity of urine? Specific gravity: concentrated or less concentrated? Magiging less concentrated. Okay, then limit amount of IV fluids to 150 mL per hour, 150 mL per hour. That’s approximately how many liters or how many mL in 8-hour duty, in one shift? That’s 150 * 8. Tama ba? So that’s 150 * 8, that’s 1200 mL lang. So meron tayong—anong meron tayo? Fluid restriction or fluid uh—fluid restriction or fluid uh—ah—anong tawag dito? Restriction or fluid enforce—fluid. Kailangan meron tayong fluid restriction kasi nga sobra na ng tubig ang kanyang katawan. Pwede mag-lead sa ano ng katawan? Yes, nagtaas pressure, magkaroon ng pulmonary edema. Yes. Okay, so that is your management. Okay, management. Another one: decreased output. Number five, number five: predispose newborn to hyperbilirubinemia. What is hyperbilirubinemia? Increased concentration of bilirubin in the blood, commonly caused by what? Hemolysis. What is hemolysis? Destruction of RBCs. Pag tumaas ang bilirubin mo, ano yung objective sign na makikita mo sa pasyente? Jaundice. Ano ulit? Jaundice. Very good. Okay, jaundice. So pwede siyang magkaroon ng jaundice. This are we clear? Hello? Are we clear? So those are the side effects of the oxytocin. So while giving oxytocin, you have to monitor that, okay. Malapit na po. So after nung induction, meron tayo number three, augmentation. Na-explain ko na ang difference ng augmentation of labor by oxytocin. Na-explain ko lang ang difference. Pag sinabing induction, may labor na ba? Wala pa. Ikaw ang nag-start. ‘To ba? Pag sinabing augmentation, may labor na ba? Yes. So ibig sabihin, are you going to give support to the labor process? Yes. Okay, so you’re going to—okay—um—um—support labor process if it [Musika] becomes weak. Okay, so support labor process if it becomes weak, irregular, and stop. Okay lang. So next, and the last one is kapag may 4 cm na tayo. Anong gagawin pag may 4 cm? Pinanin mo na ulit. Pag may 4 centimeters na, ano na gagawin? Anong gagawin natin? Amniotomy. Clear tayo? Any questions, clarifications? Alam niyo naman na ang amniotomy—tama mo ba? Yes. This is the artificial rupture of your membrane. Okay, so again, what are the side effects ng inyong oxytocin? Ay, what are the things na kailangan nating tandaan pag oxytocin? Number one, kailangan po ba meron ng IUPC? Yes. Yun ba yung cervical ripening? Pag cervical ripening, may tatlo tayong procedure diyan or method. Number one: stripping, tama ba? Yes, stripping of membrane. Number two: hygroscopic suppositories. Yung ba use of seaweed? Babalutin mo ng GS, ilalagay sa vagina. Yes. Ano naman pinakaginagamit natin for cervical ripening? Your prostaglandin, also known as misoprostol. Pwede bang tawagin na Cytotec? Yes. Anong position niya? Pag nagbigay ka kasi, pwede bang magleak? Yes. So kailangan side-lying para hindi mag-leak or hindi magtapon yung gamot. Nakakaintindihan? Yes. Pag meron na po—pag meron na pong cervical ripening, ready ka na for induction of labor, induction of labor using oxytocin. Pag nagbibigay ng oxytocin, pataasin ba ang contraction? Kapag pataas ang contraction, should you monitor for hyperstimulation? Yes. Pwede mo magkaroon ng hypertonic contraction. Kapag may hypertonic contraction, kailangan ba pababain? Yes. Kailangan mo i-relax yan. Pwede bang kontrolin ang oxytocin? Yes. Pwede bang magkaroon ng complications yan? Yes. Pag sa bata, pwede bang magkaroon ng fetal distress? Yes. Pwede maglead to fetal death? Yes. To ba mag-rupture si uterus? Yes. Are you sure? Yes. Augmentation. Kapag sinabing augmentation, kailangan po ba nag-labor na? Yes. Parehas mo ba ng effect niya sa induction? No. Yes, parehas, iba lang yung time kung kailan ka magsisimula. Are we clear? Yes. Ano yung mga side effects natin? Ah, hypotension. Meron ba? Yes. Bakit may hypotension? Meron ba tayong peripheral vasodilation? Yes. So ibig sabihin, luwang ang daanan ng dugo, bababa ang pressure. Pressure. Tama po ba? Kapag dumalaw ang—kapag bumaba ang pressure, hypotension. Kapag may hypotension, magco-compensate ba ang katawan? The heart will pump more blood, tachycardia. Compensatory ba yon? Yes. Para i-manage siya, anong gagawin natin? Monitor blood pressure. Ano next? Uterine contraction, i-monitor mo. Tama mo ba? Yes. And of course, kung kailangan i-adjust, ang i-a-adjust mo. Are we clear? Yes. Ano pa? Vomiting, sign na ba yun ng toxicity? Yes. Ang anti-oxytocin, meron ba siyang antidiuretic effect? Yes. Ang tubig, lalabas ba ng katawan? Maiiwan. Ma-retain, tension or frequency. Tension. So anong mangyayari sa solute? Diluted or concentrated? Diluted. Concentrated? Diluted. Anong tawag sa kondisyon na iyon? Water intoxication. Are you clear? Ano na yung initial signs of toxicity? Nausea and vomiting. Nausea and vomiting is, ‘to ba? And other signs includes coma. Ano ulit? Coma. Leading to that. Yes. Kaya mag-monitor ang pagbibigay ng oxytocin. Are we clear? Yes. Pwede ba tayong magbigay ng oxytocin prior to prior delivery? No, as much as possible, no, because of this possible side effects, unless there is a necessity to augment or induce the labor. Are we clear? Kailan bigay ang oxytocin, naturally? After placenta. What stage of labor? Third stage. Are we clear? After—after baby out, not placenta out, because stage 3 starts when the baby is out. Are we clear? Any question, clarification? Wala. Okay, um, tomorrow.