A client at 25 weeks' gestation has experienced a fetal demise. What medication is most likely to be used first to induce labor in this client?
1. Dinoprostone (Cervidil)
2. Methylergonovine (Ergotrate)
3. Parenteral oxytocin (Pitocin)
4. Carboprost (Hemabate)
Correct Answer: 1
Rationale 1: Dinoprostone is approved to prepare the cervix for labor or to abort a fetus that has died.
Rationale 2: This medication is not used to induce labor.
Rationale 3: Parenteral oxytocin would not be the first drug used in this client. At 25 weeks, the cervix has not ripened, so it is not wise to begin giving a medication for uterine contractions until the cervix is ready to be stretched.
Rationale 4: Carboprost is a prostaglandin that may be used for pharmacologic abortion but usually is given for this reason only into the second trimester.
Global Rationale: Dinoprostone is approved to prepare the cervix for labor or to abort a fetus that has died.
Methylergonovine is not used to induce labor. Parenteral oxytocin would not be the first drug used in this client. At 25 weeks, the cervix has not ripened, so it is not wise to begin giving a medication for uterine contractions until the cervix is ready to be stretched. Carboprost is a prostaglandin that may be used for pharmacologic abortion but usually is given for this reason only into the second trimester.
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