Oxytocin

Document discontinuation of oxytocin in the presence of non-reassuring pattern and the initiation of measures aimed at restoring a reassuring status before reinstituting this medication. Be extremely careful with oxytocin induction in the presence of a patient with prior cesarean section. A uterine rupture can trigger a claim despite the appropriateness of care.

In general, avoid the use of misoprostol for cervical ripening or induction in a patient with a history of a prevailing cesarean section. Be knowledgeable of AGOG guidelines & your hospital guidelines.


History of Cesarean SectionNBAC

Involve the patient in the process of obtaining the op note from most recent c/s and explain the importance of doing so and the difficulties sometimes encountered in obtaining those records. The patient shares this responsibility. Patients whose records do not include valid previous op note records are not ideal candidates for VBAC.

Patients who refuse close monitoring of fetal status are not ideal candidates for VBAC. It is recommend using a printed form signed by the patient for VBAC consent to further document the conversation about the pros and cons of VBAC. The discussion can include mention of relative maternal and fetal safety issues, the limitations of diagnosis of uterine rupture and the consequences of uterine rupture. Be frank and informative with the patient.

Avoid the use of misoprostol for VBAC induction. Although the judicious use of oxytocin is perfectly legitimate for the appropriate VBAC candidate, a recent review showed uterine rupture was associated with the use of oxytocin or other oxytocic agent intrapartum.

Group B Streptococci Carriers

• Consider screening all patients at 34-37 weeks for Beta Strep
  
  
• Consider prophylactic treatment for patients whose status is unknown
  
  
• While no method of sending records is foolproof, have a known system in place for updating antenatal records as to GBS status

Page 1: Fetal Monitoring and Related Delivery Decisions
Page 2: Important Facts about Cerebral Palsy
Page 3: Oxytocin, History of Cesarean Section/VBAC, Group B Streptococci Carriers
Page 4: Shoulder Dystocia, Placental Pathology, Documentation & Records