C H A P T E R 4 0
Drugs affecting the female reproductive system
623
Prototype summary: Dinoprostone
Indications:
Evacuation of the uterus in the
management of missed abortion or intrauterine
fetal death; management of non-metastatic
gestational trophoblastic disease; initiation of
cervical ripening.
Actions:
Stimulates the myometrium of the pregnant
uterus to contract, evacuating the contents of the
uterus.
Pharmacokinetics:
Route
Onset
Peak
Duration
Intravaginal
10 mins
15 mins 2–3 hours
T
1/2
:
5 to 10 hours, with tissue metabolism and
excretion in the urine.
Adverse effects:
Headache, paraesthesias,
hypotension, vomiting, diarrhoea, nausea, uterine
rupture, uterine or vaginal pain, chills, diaphoresis,
backache, fever.
Care considerations for
women receiving prostaglandins
Assessment: History and examination
■
■
Assess for contraindications or cautions: history
of allergy to any prostaglandin preparation
to
avoid hypersensitivity reactions
; active PID,
which
could be exacerbated by the increased uterine
activity
; cardiac, hepatic, pulmonary or renal
disease problems,
which could be exacerbated
by the effects of the drug
; history of asthma,
which predisposes the woman to hypersensitivity
reactions
; hypotension, hypertension and epilepsy,
which require cautious use of the drug
; and
scarred uterus or acute vaginitis,
which could be
exacerbated by the strong uterine contractions.
■
■
Perform a complete physical assessment before
beginning therapy
to establish baseline status
and
during therapy
to determine drug effectiveness
and evaluate for any potential adverse effects.
■
■
Confirm date of last menstrual period and
estimated duration of pregnancy
to ensure
appropriate use of the drug.
■
■
Assess vital signs, including skin and lesions;
orientation and affect; and blood pressure, pulse
and respiration; and auscultate lung sounds,
to
monitor for vascular effects, including bleeding
and hypersensitivity reactions.
■
■
Assist with or complete a pelvic examination,
observe for vaginal discharge and evaluate uterine
tone to
monitor effectiveness of the drug and the
occurrence of adverse effects.
■
■
Monitor the results of laboratory tests, including
complete blood count, leucocyte count,
haemoglobin and haematocrit,
to monitor for
excess bleeding
, and urinalysis
to monitor
for potential infection or reaction to the
procedure.
Implementation with rationale
■
■
Administer via route indicated, following
the manufacturer’s directions for storage and
preparation,
to ensure safe and therapeutic use of
the drug.
■
■
Confirm the pregnancy gestation before
administering the drug
to ensure appropriate use
of the drug.
■
■
Confirm that termination or uterine evacuation is
complete by assessing vaginal bleeding and passing
of tissue in the vaginal blood
to avoid potential
bleeding problems;
prepare for dilation and
curettage if necessary
to stop excessive blood loss
.
■
■
Monitor blood pressure frequently during and
after administration
to assess for adverse effects
;
discontinue the drug if blood pressure rises
dramatically.
■
■
Monitor uterine tone and involution and the
amount of bleeding during and for several days
after use of the drug
to ensure appropriate
response to and recovery from the drug.
■
■
Provide support and appropriate referrals
to help
the woman deal with the termination or fetal
death.
■
■
Provide teaching, including monitoring necessary
during drug administration, comfort measures,
signs and symptoms of adverse effects, measures to
minimise or prevent adverse effects, danger signs
and symptoms to report immediately, need for
follow-up monitoring and evaluation and sources
for support and referrals
to enhance the person’s
knowledge about drug therapy and to promote
compliance.
Evaluation
■
■
Monitor woman’s response to the drug (evacuation
of uterus).
■
■
Monitor for adverse effects (GI upset, nausea,
blood pressure changes, haemorrhage, uterine
rupture).
■
■
Evaluate the effectiveness of the teaching plan
(woman can name drug, dosage, adverse effects to
watch for and specific measures to avoid them).
■
■
Monitor the effectiveness of comfort measures and
compliance with the regimen.
