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A nurse is assisting with the care of a 30-year-old female client who is scheduled to receive a dose of dinoprostone in the maternal newborn unit.

 

Exhibit 1: Vital Signs

 

• Heart rate: 88/min
• Temperature: 37.1°C (98.8°F)
• Respiratory rate: 16/min
• Blood pressure: 122/78 mm Hg

 

Exhibit 2: Provider Prescriptions

 

• Levothyroxine 100 mcg PO once daily in PM
• Acetaminophen 325 mg PO every 6 hr PRN
• Dinoprostone 10 mg intravaginally x one dose now
• Terbutaline 2.5 mcg/min intravenous per provider's instructions

 

Exhibit 3: Laboratory Results

 

• WBC count: 9,500/mm³ (Normal: 5,000 to 15,000/mm³)
• Hgb: 10.5 mg/dL (Normal: greater than 11 mg/dL)
• Hct: 31% (Normal: greater than 33%)
• Platelets: 225,000/mm³ (Normal: 150,000 to 400,000/mm³)
• Blood Type/Rh: O+

 

Exhibit 4: Assessment

 

The fetal heart rate is 140/min with moderate variability, and mild uterine irritability is noted. The abdomen is soft and nontender upon palpation. Cervical examination reveals dilation of 1 cm, thickness, and no presenting part palpable. An ultrasound shows a footling breech presentation. There are clusters of lesions noted on the vaginal introitus and labia majora.

 

Exhibit 5: History and Physical

 

The client is gravida 2 para 1, with a previous vaginal delivery. She has a history of hypothyroidism and Herpes simplex virus type 2. She is currently undergoing labor induction at 39 weeks and 3 days of gestation.

 

Querry

For which of the following findings should the nurse anticipate a provider's prescription to withhold the dinoprostone? Select all that apply.

Choice A rationale:

Breech presentation is a contraindication for dinoprostone as it increases the risk of complications during labor and delivery. Using dinoprostone to induce labor in a non-vertex presentation can lead to issues such as cord prolapse or obstructed labor, which necessitate a cesarean section for safe delivery.

Choice B rationale:

Terbutaline administration is used to manage preterm labor by relaxing the uterus. While it is relevant in labor management, it does not directly contraindicate the use of dinoprostone. Terbutaline and dinoprostone can be used in conjunction if properly managed.

Choice C rationale:

Fetal heart rate (FHR) monitoring showing abnormalities is a potential reason to withhold dinoprostone. Dinoprostone can increase uterine contractions, potentially stressing the fetus. A stable FHR with moderate variability indicates fetal well-being; however, if there were concerns, the provider might withhold dinoprostone.

Choice D rationale:

A WBC count of 9,500/mm³ is within the normal range and does not indicate an infection or condition that would contraindicate dinoprostone use. Elevated WBC count could raise concerns, but in this case, it is normal and not a contraindication.

Choice E rationale:

Lesions noted on the vaginal introitus and labia majora, likely caused by Herpes simplex virus, are a contraindication for dinoprostone. Active genital herpes lesions increase the risk of neonatal herpes transmission, making vaginal delivery risky. In such cases, cesarean delivery is often preferred to prevent transmission.