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•inform patient that she may experience a warm feeling in her vagina during administration. Cervidil INDICATIONS: •used to “ripen” the cervix in pregnancy at or near term when induction of labor is indicated. •Induction of mid trimester abortion. •Management of missed abortion up to 28 weeks. •management of nonmetastatic gestational trophoblastic disease ACTION: •produces contractions similar to the occurring during labor at term by stimulating the myometrium. •initiates softening effacement, and dilation of the cervix “ripening”. •also stimulates GI smooth muscle. THERAPEUTIC EFFECT(S):•initiation of labor. •expulsion of fetus. CONTRAINDICATIONS/PRECAUTIONS: •Hypersensitivity to prostaglandins or additives in the gel or suppository. •Should be avoided in situations in which prolonged uterine contractions should be avoided including: previous cesarean section or uterine surgery, cephalopelvic disproportion, traumatic delivery or diﬃcult labor, multi-parity, hyperactive or hypertonic uterus, fetal distress (if delivery is not imminent), unexplained vaginal bleeding, placenta previa, vasa previa, active herpes genitalis, obstetric emergency requiring surgical intervention. situations in which vaginal delivery is contraindicated, presence of acute pelvic inflammatory disease ,or ruptured membranes •concurrent oxytocin therapy. •USE CAUTIOUSLY IN: uterine scarring, asthma, hypotension, cardiac disease, adrenal disorders, anemia, jaundice, diabetes mellitus, epilepsy, glaucoma, pulmonary, renal, or hepatic disease, multiparity, women >30 years, those with complications during pregnancy, and those with a gestational age >40 weeks. SERIOUS SIDE EFFECTS: •amniotic fluid embolism, •uterine rupture, •anaphylaxis.ASSESSMENT:•monitor frequency, duration, and force of contractions and uterine resting tone. •monitor uterine activity, fetal status, and dilation and effacement of cervix continuously throughout therapy. IMPLEMENTATION:
•place vaginal insert transversely in the posterior vaginal fornix immediately after removing from foil package. PATIENT TEACHING: •explain purpose of medication and vaginal exams. •inform patient that she may experience a warm feeling in her vagina during administration.Misoprostol PGE1 INDICATIONS: •cervical ripening and labor inductionACTION: •causes uterine contractions THERAPETIC EFFECT(S): •with mifepristone terminates pregnancy less than 49 days. CONTRAINDICATIONS/PRECAUTIONS: •hypersensitivity to prostaglandins •OB: should not be used to prevent NSAID-induced gastric injury due to potential for fetal harm or death. •LACTATION: may cause severe diarrhea in the nursing infant. •USE CAUTIOUSLY IN: OB: patients with childbearing potential should be counseled to avoid pregnancy during misoprostol therapy for prevention of NSAID-induced gastric injury. pregnancy should be determined before initiating therapy •EXERCISE EXTREME CAUTION IN: when used for cervical ripening may cause uterine rupture