Prostaglandins: Nursing Pharmacology

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DRUG NAMEmisoprostol (Cytotec)dinoprostone (Cervidil, Prepidil, Prostin E2)
Prostaglandin E1 analog (PGE1)
Prostaglandin E2 (PGE2)
  • Stimulates collagenase in the cervix, promoting cervical ripening
  • Increases intracellular calcium within uterine smooth muscle cells, stimulating uterine contraction
  • Induction and management of abortion
  • Cervical ripening
  • Control postpartum hemorrhage
  • Cervical ripening
  • Management of spontaneous abortion
  • Induction of abortion
  • IVAG, endocervical (dinoprostone)
  • IVAG, sublingual, buccal, rectal, PO (misoprostol)
  • Uterine hyperstimulation
  • Abnormal fetal heart rate
  • Nausea
  • Vomiting
  • Diarrhea
  • Diaphoresis
  • Cardiac arrhythmias
  • Disseminated intravascular coagulation
  • Amniotic fluid embolism
  • Previous cesarean section or other uterine surgery
  • Grand multiparity
  • Cephalopelvic disproportion
  • Unfavorable fetal position
  • Placenta previa
  • Pelvic infection
  • Active genital herpes
  • Asthma
  • Glaucoma
  • Hepatic, renal, respiratory, or cardiovascular disease
MISOPROSTOL (CYTOTEC)When using prostaglandins for cervical ripening

Prior to administration
  • Reinforce education provided by obstetrician / midwife
  • Assessments: contraindications and precautions; cervical status, fetal lie, fetal position; baseline uterine and fetal heart monitoring
  • If administering misoprostol, have terbutaline readily available

After administration
  • Keep client supine 15–30 minutes after receiving gel or for two hours after receiving vaginal insert
  • Assessments: uterine activity, FHR, maternal vital signs; monitor for side effects
  • Therapeutic response: cervical softening, minimal uterine activity, normal FHR
  • Undesired outcomes: hyperstimulation; monitor FHR for indeterminate / abnormal patterns
  • Provide comfort measures as needed
DINOPROSTONE (CERVIDIL, PREPIDIL, PROSTIN E2)When using misoprostol to control postpartum hemorrhage
  • Teaching: expect uterine contractions and decreased bleeding
  • Assessments: uterine tone, amount of bleeding, vital signs; monitor for side effects
  • Therapeutic response: increased uterine tone, control of hemorrhage
  • Undesired outcomes: continued hemorrhage
  • Provide comfort measures as needed

Memory Anchors and Partner Content



Victoria S. Recalde, MD

Katherine May, BSN, RN

Kaylee Neff

Jessica Reynolds, MS

Prostaglandins are a group of molecules released by most cells in the body that can have effects on different tissues and organs, including the uterus, where they cause cervical ripening and uterine muscle contraction.

Prostaglandins include dinoprostone, also referred to as PGE2, and misoprostol, also referred to as PGE1. Dinoprostone is a naturally occurring prostaglandin E2 that comes in the form of a gel for endocervical administration, or vaginal insert administered intravaginally.

Dinoprostone is typically used to facilitate labor by inducing cervical ripening, to induce abortion in the second trimester, or to evacuate the uterus when there’s a spontaneous abortion or intrauterine fetal death, as well as to manage a benign hydatiform mole.

Misoprostol, on the other hand, is a synthetic prostaglandin E1 analog that can be administered intravaginally and sometimes orally for cervical ripening.

It is also used to control postpartum hemorrhage, for treatment of incomplete or missed abortion, and to induce abortion when administerd with mifeprostone, a progestrone agonist.

Once administered, prostaglandins stimulate secretion of collagenase in the cervix, which degrade collagen.


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