Unique Plan Description: OB Cervical Ripening Prostaglandin
Plan Selection Display: OB Cervical Ripening Prostaglandin
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2021-10-14 09:16:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-04-29 15:05:04
Available at all facilities: Yes

OB Cervical Ripening Prostaglandin
Vital Signs
	Vital Signs
		T;N, Q1H, 2, Dose(s)/Time(s)
		T;N, Q4H, 3, Dose(s)/Time(s)
Activity
	Ambulate
		T;N+30
			Comment: Patient may ambulate 30 minutes after cervical ripening medication administration, with continuous monitor
	Bedrest
		T;N, Supine
			Comment: Supine, with hip wedge, for 30 minutes after administration
Diet
	Regular Diet
		T;N+120
			Comment: as tolerated, after cervical ripening medication administration and/or no active labor
	NPO
		T;N, After Midnight, NPO Except for: NPO Except For Ice
Medications
		Select medication  below for Cervical Ripening Vaginal-Misoprostol(NOTE)*
	Cytotec
		25 mcg, Tab, VAGINAL, Q4H, PRN, cervical ripening, 24 hr
			Comment: Oxytocin should not be administered for at least 4 hours after last dose of Misoprostol; use 50mcg dosage with caution.  Nurse may administer Misoprostol if baseline reactive NST and ongoing fetal heart rate monitoring tracing Category I, Bishop score is < 8 and fewer than 5 contractions in 30 minutes.
		50 mcg, Tab, VAGINAL, Q4H, PRN, cervical ripening, 24 hr
			Comment: Oxytocin should not be administered for at least 4 hours after last dose of Misoprostol; use 50mcg dosage with caution.  Nurse may administer Misoprostol if baseline reactive NST and ongoing fetal heart rate monitoring tracing Category I, Bishop score is < 8 and fewer than 5 contractions in 30 minutes.
		Select medication below for Cervical Ripening Oral-Misoprostol(NOTE)*
		50 mcg, Tab, By Mouth, Q4H, PRN, cervical ripening, 24 hr
			Comment: Oxytocin should not be administered for at least 4 hours after last dose of Misoprostol.  Nurse may administer Misoprostol if baseline reactive NST and ongoing fetal heart rate monitoring tracing Category I, Bishop score is < 8 and fewer than 5 contractions in 30 minutes.
		100 mcg, Tab, By Mouth, Q4H, PRN, cervical ripening, 24 hr
			Comment: Oxytocin should not be administered for at least 4 hours after last dose of Misoprostol.  Nurse may administer Misoprostol if baseline reactive NST and ongoing fetal heart rate monitoring tracing Category I, Bishop score is < 8 and fewer than 5 contractions in 30 minutes.
		Select medication  below for Cervical Ripening Vaginal-Cervidil(NOTE)*
	Cervidil 0.3 mg/hr vaginal insert
		10 mg, Insert, VAGINAL, Once, T;N
	cervidil removal
		Removal, Insert, VAGINAL, Once, PRN, see comment
			Comment: 12 hours after insertion or when active labor begins, and /or if Category III FHR pattern occurs.  Oxytocin should not be administered for 30-60 minutes after removal of Cervidil.  PRN, after consultation with HCP, may remove Cervidil if tachysystole (more than 5 uterine contractions in 10 minutes, averaged over a 30 minute window present and/or Category II FHR pattern)
PRN
	Ambien
		5 mg Tab BY MOUTH QHS, PRN insomnia
Patient Care

	Vaginal Exam
		T;N
			Comment: prior to administration of cervical ripening medication. Document Bishop score
	Fetal and Uterine Contraction Monitoring
		T;N
			Comment: Intermittent or continuous based on the presence of risk factors. CONTINUOUSLY, after cervical ripening medication administration.
	Shower
		T;N, QHS, 1, Dose(s)/Time(s)
			Comment: with chlorhexidine gluconate
	Notify
		T;N, MWH only: Provider/Resident to perform bedside US to check for vertex

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase