Prostaglandins: Cervical Ripening and Labor Induction

Prostaglandins are used to ripen the cervix, softening, effacing, and beginning dilation, before or during labor induction. They bind prostaglandin receptors in the cervix and uterus, triggering changes that soften the cervix and stimulate contractions. The nurse must know which clients are candidates, the contraindications, the positioning and monitoring after administration, and the signs that require stopping the drug, because prostaglandins can overstimulate the uterus and endanger the fetus. Two agents dominate: misoprostol, a prostaglandin E1 analog given intravaginally, buccally, or orally, and dinoprostone, a prostaglandin E2 product available as a vaginal gel or a removable vaginal insert. The Bishop score guides whether ripening is needed and when to stop. Consider a case: you are the nurse caring for a client who received a dinoprostone vaginal insert and now has six contractions in 10 minutes with a category change in the fetal heart rate. Which action is the priority? You recognize uterine tachysystole, remove the insert by its retrieval string, reposition the client on her side, increase intravenous fluids, and notify the provider, because sustained overstimulation reduces placental perfusion and...