Prostaglandins

Prostaglandins are used to ripen the cervix (soften, efface, and begin dilation) before or during the induction of labor. They work by binding to prostaglandin receptors in the cervix and uterus, triggering inflammatory-like changes that soften and dilate the cervix, and stimulating uterine contractions. Two agents: - Misoprostol (PGE1) — intravaginal tablet (also available buccally and orally). Inexpensive, widely used, potent. - Dinoprostone (PGE2) — available as vaginal gel (Prepidil), vaginal insert (Cervidil), or suppository (Prostin E2 for abortion). Bishop Score determines whether cervical ripening is needed. A Bishop score ≤4 indicates an unripe cervix; prostaglandins are indicated. A score ≥8 indicates a ripe cervix — prostaglandins should be discontinued at this point. Contraindications (box 29.2 content): - Active cardiac, hepatic, pulmonary, or kidney disease - Acute pelvic inflammatory disease - Client fever or infection - Clients in whom vaginal delivery is contraindicated (malpresentation, placenta previa) - History of cesarean section or major uterine surgery - History of difficult or traumatic labor - Nonreassuring fetal heart rate pattern - Regular progressive uterine contractions already present - Significant cephalopelvic disproportion Treatment...