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Case Study

Tatiana is 42 weeks pregnant and shows signs of pregnancy-induced hypertension. Her healthcare provider recommends inducing labor with prostaglandin gel. To determine if Tatiana's cervix is ready for induction, her healthcare provider will use the Bishop score system which evaluates dilation, position, effacement and station of the cervix. Dinoprostone gel will be administered into Tatiana's vagina by a healthcare professional to relax and dilate her cervix and cause contractions. The maximum dosage is 3 doses in 24 hours with a 6 hour interval between doses. Oxytocin should not be started for induction until at least 4 hours after the last gel dose to prevent overstimulation of the uterus.

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Ayanami Pascua
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28 views

Case Study

Tatiana is 42 weeks pregnant and shows signs of pregnancy-induced hypertension. Her healthcare provider recommends inducing labor with prostaglandin gel. To determine if Tatiana's cervix is ready for induction, her healthcare provider will use the Bishop score system which evaluates dilation, position, effacement and station of the cervix. Dinoprostone gel will be administered into Tatiana's vagina by a healthcare professional to relax and dilate her cervix and cause contractions. The maximum dosage is 3 doses in 24 hours with a 6 hour interval between doses. Oxytocin should not be started for induction until at least 4 hours after the last gel dose to prevent overstimulation of the uterus.

Uploaded by

Ayanami Pascua
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PASCUA, AYANAMI T.

MARCH 10, 2023


BSN 2-B MA’AM JOCELYN ONA

CASE STUDY

Tatiana, gravida 3, para 0, is at 42 weeks' gestation. At her prenatal visit, her health care provider
notes signs and symptoms of pregnancy-induced hypertension and advises her about a plan to
induce labor after administration of prostaglandin gel. She asks the nurse, "Can you help me
understand all of these?"

1. What objective scoring tool (scoring system) can be used to predict the extent to which the
patient's cervix is "ripe" and therefore favorable for successful induction?

In this instance, the bishop scoring system will be applied. The bishop score is a calculation that will
determine how close Tatiana is to labor. Based on changes in her cervix and the position of her
baby's head, the healthcare professional will inspect her cervix and calculate her bishop score. Her
final score can help determine if induction will lead to a successful vaginal birth.

SCORE DILATION (CM) POSITION OF CERVIX EFFACEMENT (%) STATION CERVICAL


(-3 TO +3) CONSISTENCY

0 Closed Posterior 0-30 -3 Firm


1 1-2 Mid-position 40-50 -2 Medium
2 3-4 Anterior 60-70 -1,0 Soft
3 5-6 --- 80 +1, +2 ---

The patient's health care provider orders dinoprostone gel for use in the cervix.

2. What will be accomplished with use of the gel?

A prostaglandin or hormone-like substance, called dinoprostone is given to pregnant women to relax


the cervix's muscles in preparation for inducing labor toward the end of the pregnancy. Dinoprostone
will work by causing Tatiana’s cervix to thin and dilate (open) and the uterus to contract (cramp) the
way it does during labor. As the gel is absorbed, contraction of Tatiana might start to occur.
3. Who will administer the gel?

The gel will be administered by a health care professional since a syringe will be used and inserted
high into the vagina, close to the cervix.

4. How often can the gel be administered?

A 6-hour interval between doses is advised for the repeat dose of 0.5 mg dinoprostone (the maximum
recommended dosage is 1.5 mg of dinoprostone which is equivalent to 3 doses in 24 hours). Based
on the progress of patient outcomes, the attending physician must decide whether an extra dose is
necessary and at what interval.

5. How long after the last dose of gel can the IV oxytocic medication be started to induce labor?

Oxytocin can be started on a case-to-case basis, but it is not advised to use it in less than 4 hours
after the gel insertion. If the patient's uterine activity is still present after administration of the
prostaglandin gel, oxytocin should be administered with extreme caution.

6. Why is there a waiting period before starting the oxytocin?

The reason why we need to wait or should not start oxytocin for 6 to 12 hours after the placement of
the last dose of dinoprostone, is to allow for the spontaneous onset of labor and protect the uterus
from overstimulation. This overstimulation can cause the uterus to contract too frequently. Too-
frequent contractions may lead to complications, this could cause painful contractions, and lead to
uterine rupture and hemorrhage. It could even restrict placental blood flow, resulting in abnormal fetal
heart rate patterns.

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