Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 42 weeks gestation.
The nurse recognizes that this medication will be administered to:

Choice A rationale

While many inductions of labor are performed for medical reasons, such as preeclampsia or post-term pregnancy, not all are. Elective inductions, performed for non-medical reasons, are also common, although they are associated with certain risks. The decision to induce labor is a medical one, but the indication is not always strictly medical, making this statement inaccurate.

Choice B rationale

A trial of labor (TOL) is a term used specifically for patients who have had a prior cesarean section and are attempting a vaginal delivery. It is also known as a TOLAC (Trial of Labor After Cesarean). Induction of labor is a broader term and refers to stimulating contractions before the spontaneous onset of labor. The two terms are not synonymous.

Choice C rationale

Induction of labor is a process initiated by methods like oxytocin infusion or prostaglandin gels. Internal and external version are procedures used to change the fetal presentation (e.g., from breech to cephalic) and are not methods for initiating labor. These procedures may be followed by induction, but they are not the induction methods themselves.

Choice D rationale

The Bishop score is a scoring system used to predict the likelihood of a successful induction of labor. It assesses five components: cervical dilation, effacement, consistency, position, and fetal station. A higher Bishop score (typically 8 or greater) indicates a more favorable cervix and a greater chance of successful induction, making this a crucial assessment tool.

Choice A rationale

Prostaglandin gels, like Prepidil, primarily function by modifying the cervical tissue, not by directly stimulating the amniotic membranes to rupture. Amniotomy, the artificial rupture of membranes, is a separate procedure often performed once the cervix is favorable, but it is not the direct effect of prostaglandin administration. This medication's mechanism is focused on tissue changes to prepare the cervix.

Choice B rationale

Prostaglandin gels do not have a direct mechanism of action to increase amniotic fluid volume. Amniotic fluid volume is primarily regulated by fetal renal function, swallowing, and placental exchange. The purpose of this medication is to facilitate cervical ripening, which is a prerequisite for labor induction, not to alter the fluid environment surrounding the fetus.

Choice C rationale

Prostaglandins do not enhance uteroplacental perfusion. This medication's primary pharmacological effect is localized to the cervix, where it causes cervical softening and effacement by breaking down collagen fibers and increasing water content. Uteroplacental perfusion is a complex circulatory process that ensures adequate oxygen and nutrient exchange, and it's not the target of this drug.

Choice D rationale

Prepidil, which contains dinoprostone, is a prostaglandin E2 analog. Its primary action is to promote cervical ripening by stimulating the breakdown of collagen and increasing the water content of the cervix. This leads to cervical softening, effacement, and dilation, making the cervix more favorable for subsequent induction with oxytocin. The goal is to prepare the cervix for the mechanical forces of labor.