A client at 38 weeks' gestation is admitted for induction of labor. Her membranes ruptured 12 hours ago. There are no other signs of labor. Which medication does the nurse anticipate will be prescribed?

Appeared in: BHU NO-2019

Explanation

Oxytocin is a uterotonic agent that directly stimulates the myometrium to produce rhythmic, coordinated uterine contractions, which is the primary goal for inducing labor.
In cases of term premature rupture of membranes (PROM) without spontaneous labor, inducing contractions is necessary to facilitate delivery and reduce the risk of maternal and fetal infection (chorioamnionitis).
Clinical guidelines support the use of oxytocin to stimulate labor after membrane rupture to reduce the time to delivery.

Option A: Dinoprostone is a prostaglandin primarily used for cervical ripening (softening and effacing the cervix), not for inducing strong, active labor contractions. Its use is also more cautious after membranes have ruptured due to an increased risk of infection.
Option C: Magnesium Sulfate is a tocolytic, meaning it relaxes the uterus and suppresses contractions. This action is the direct opposite of the clinical goal, which is to induce labor.
Option D: Estrogen is a hormone essential for maintaining pregnancy and preparing the uterus for labor, but it is not administered as a medication to induce labor contractions.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacological induction of labor following premature rupture of membranes (PROM) to guide bedside assessment, documentation, and the next nursing action.
The nurse's primary responsibility during oxytocin infusion is continuous monitoring of the fetal heart rate and uterine contraction pattern to prevent uterine tachysystole (>5 contractions in 10 minutes) and fetal distress, which are significant risks.
Prolonged rupture of membranes (generally considered greater than 18-24 hours) significantly increases the risk of chorioamnionitis. Prompt induction of labor is a key nursing and medical priority to mitigate this risk.
What if? If the client's cervix was found to be unfavorable (e.g., a low Bishop score), the provider might first prescribe a cervical ripening agent like Dinoprostone or use a mechanical method (like a Foley balloon) before starting Oxytocin. However, Oxytocin would still be the definitive medication to induce powerful, coordinated contractions for labor progression.

How to Approach the Question

First, identify the core clinical problem: a term pregnant client (38 weeks) with ruptured membranes for 12 hours needs labor to be induced.
Next, analyze the client's status: membranes are ruptured, but labor has not started. The goal is to start effective uterine contractions.
Evaluate each medication option based on its primary pharmacological action in obstetrics.
Ask yourself: 'Which of these drugs causes uterine contractions to induce labor?' Oxytocin is the direct answer.
Differentiate between agents for cervical ripening (like Dinoprostone) and agents for inducing contractions (Oxytocin). Since the question asks for a medication to induce labor after PROM, Oxytocin is the most direct and standard choice.

Concept Tested & Keywords

Concept Tested: Pharmacological induction of labor following premature rupture of membranes (PROM).
Stem keywords: 38 weeks' gestation, induction of labor, membranes ruptured 12 hours ago, no signs of labor
Lead-in keywords: Which medication
Clinical cues: Membranes ruptured 12 hours ago: This indicates term PROM, increasing the risk of infection (chorioamnionitis) and creating an indication for labor induction.
Clinical cues: No other signs of labor: Confirms that spontaneous labor has not begun, necessitating pharmacological intervention.

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E6 Obstetrics Williams p. 80-94

E6 Pharmacology Katzung 16e p. 527-529

Practise the full BHU NO-2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.