12.05 Prostaglandins

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Overview

  1. Given for two reasons
    1. Stimulate uterine contractions
    2. Cervical ripening (getting the cervix ready by helping it to dilate and efface)
  2. Given as part of an induction of labor or abortion

Nursing Points

General

  1. It is given ahead of time – if an induction with oxytocin (Pitocin) is scheduled, they will typically get a prostaglandin to ripen the cervix the night before
    1. We’ve got to soften the cervix before artificially starting contractions to be more successful
  2. MD will check the mother’s cervix first
    1. Already dilated→ won’t need ripening
  3. Route: vaginal suppository or gel

Assessment

  1. Contraindications
    1. Acute PID
    2. History of c-section, difficult or traumatic birth, major uterine surgery
    3. Any vaginal bleeding or placenta previa
    4. Consistent contractions
    5. Dilated/effaced
  2. Side effects to assess for
    1. Overstimulation of uterine muscles
    2. Tachysystole: when there are more than 6 contractions in 10 minutes (or more frequently than q 2 minutes)

Therapeutic Management

  1. Baseline vitals on mom and fetal heart tones
  2. Bishop Score –used to evaluate if induction is necessary and/or will be successful
    1. Add scores→ Score of 8-10 means spontaneous labor is likely, <7 spontaneous labor not likely and induction is necessary and may or may not be successful
      1. Dilation
        1. 0 = 0 cm
        2. 1 = 1-2 cm
        3. 2 = 3-4 cm
        4. 3 = > 5 cm
      2. Effacement
        1. 0 = 0-30 %
        2. 0 = 40-50 %
        3. 0 = 60-70 %
        4. 0 = > 80 %
      3. Consistency
        1. 0 = Firm
        2. 1 = Medium
        3. 2 = Soft
      4. Position
        1. 0 = Posterior
        2. 1 = Midposition
        3. 2 = Anterior
      5. Station
        1. 0 = -3
        2. 1 = -2
        3. 2 = -1
        4. 3 = +1, +2
  3. Assist provider in procedure (follow hospital protocol)

Nursing Concepts

  1. Pharmacology
  2. Clinical judgement
  3. Safety

Patient Education

  1. What prostaglandin will be used for
  2. Void prior to procedure
  3. What to expect

Reference Links

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Video Transcript

In this lesson I will help you understand the role of prostaglandins in induction of labor and your role with their use.
First let’s talk about the uses of prostaglandins. They are given for two reasons. To stimulate uterine contractions and for cervical ripening. Ripening is when the cervix is prepared and softened to be more ready to dilate and efface. These prostaglandina are given as either part of an induction of labor or for an abortion.

Ok so the procedure for this it to check the cervix. If there is already dilation or effacement then the cervix doesn’t need to be ripened. It is given usually the night before to ripen and soften that cervix and then oxytocin or Pitocin is given the following day. So the cervix needs to be ready to do its job before contractions are initiated. It will be given as a vaginal suppository or gel. Cytotec and Cervidil are the prostaglandins used for this.
Our patient needs to be assessed for a few things. First we need to ensure there is no contraindications. So this would be pelvic inflammatory disease, any history of c-sections, difficult previous vaginal delivery, or major uterine surgery. If a patient has had a c-section or uterine surgery is not recommended to induce labor because it could cause uterine rupture at the incision site. If there has been a previous traumatic vaginal delivery we might not want them to delivery vaginally if they are at risk for the same event occurring. Also has there been any vaginal bleeding or placenta previa. If the placenta is covering the cervix they can not deliver vaginaly and if there is vaginal bleeding we need to know why. If the patient is already showing laboring signs we don’t need to induce labor. So is she having consistent contractions or already dilated and effaced. If dilation and effacement have happened then her cervix is already ripened and doesn’t require prostaglandins. We will also be assessing for side effects. So this would be overstimulation of uterine muscles. Prostaglandins can cause the uterus to get irritated and contract and could cause overstimulation or tachysystole. So the patient has more than 6 contractions in 10 minutes or contractions more frequently than every 2 minutes. If there are contraindications or side effects that occur then we need to let the doctor know just say “hey our patient has been contracting and her cervix is already 3 cm”.

So management will be to get baseline vitals on mom and fetal heart tones and assisting the provider with inserting the prostaglandin. Part of the patients management will be to perform the bishop score and this is used to evaluate if induction is necessary or if it will be successful. As you can see in the image scores of 0 to 3 are given for cervical dilation and effacement. The fetal station is scored as well as the cervical consistency and position of the cervix. If the score is less than 7 spontaneous labor is not likely to occur and induction is necessary.

Our concepts are pharmacology because this is medication, clinical judgement because if we will there is a contraindication then we need to make that judgement and notify the provider and safety because we are looking out for the safety of our patient with these medications and ensuring the fetus and mom are safe.

Ok let’s review. Our prostaglandins are cervidil and cytotec that are inserted vaginally. They are used to induce labor or for abortion. They ripen the cervix and can stimulate uterine contractions. They can be contraindicated in some situations like vaginal infections, previous uterine surgery, past traumatic deliveries, or bleeding. The Bishop’s score is used to see if induction is warranted and could be successful. A score above 7 means spontaneous labor is likely to occur and less than 7 means an induction is necessary.

Make sure you check out the resources attached to this lesson and review the Bishop’s scoring tool. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 5

A pregnant client with a Bishop’s score of 8 means which?

  • Question 2 of 5

A pregnant client is having strong contractions every 90 seconds. What is the most appropriate way to document this?

  • Question 3 of 5

A pregnant client is admitted to receive prostaglandins for induction. What should be included in the plan of care? Select all that apply.

  • Question 4 of 5

A pregnant client arrives to the unit for her induction with cervidil. The nurse assesses her cervix and finds it to be 4 cm and anterior. What should the nurse do next for this client’s plan of care?

  • Question 5 of 5

A nurse is gathering a health history for a pregnant client who has arrived for a cervidil induction. Which of the following would be contraindications? Select all that apply.

Module 0 – OB Course Introduction

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