23.07 Prostaglandins in Pregnancy

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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

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