PLACE LABEL HERE
Cervical Ripening
Orders
The following orders will be implemented. Orders with a “q” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
INDICATION FOR INDUCTION:
qAbruptio placentae / q Premature rupture of membranes (PROM)q Chorioamnionitis / q Postterm (> 41.0 weeks)
q Gestational hypertension / q Maternal medical condition (e.g., diabetes, chronic pulmonary disease, renal disease, chronic hypertension, antiphospolipid syndrome, etc.)
q Preeclampsia/eclampsia/HELLP / q Fetal compromise (e.g., severe IUGR, oligohydramnios, isoimmunization, abnormal BPP, etc.)
q Elective ______/ q Other ______
q INDUCTION Estimated Gestational Age: ______ / PELVIC EXAMINATION
Confirmation of Term Gestation, if elective:
q Fetal heart tones have been documented for 20 weeks by nonelectronic fetoscope or for 30 weeks by Doppler.
q It has been 36 weeks since a positive serum or urine hCGpregnancy test was performed by a reliable laboratory.
q An ultrasound measurement of the crown/rump length, obtained at 6-12 weeks, supports a gestational age of at least 39 weeks.
q An ultrasound obtained at 13-20 weeks confirms the gestational age of at least 39 weeks determined by clinical history and physical examination.
q Amniocentesis and documentation of fetal maturity. / Pelvis: q Adequate q ______
Cervical Exam:
Position: qPosterior qIntermediate qAnterior
Consist: q Firm qIntermediate qSoft
Dilation: ______
Effacement:______
Station: ______
1. Status: Admit as Inpatient to Labor & Delivery
2. External fetal monitoring for 20 min before initiation of cervical ripening. For Category II or III FHR pattern, hold dose and notify physician/CNM.
3. Continuous EFM, and tocodynamometer (toco). If using Cytotec (misoprostol) and patient not having regular uterine contractions, may intermittently monitor FHR and toco after 4 hrs of administration of each dose if Category I tracing is present.
4. Diet: only sips of clear liquids until 2 hrs after administration of scheduled medication, then as tolerated
OR q ______
5. Activity: bed rest in lateral recumbent position for 2 hrs following medication administration, then may have BRP
OR q strict bedrest
6. BP, pulse, respirations q hr for the first 2 hrs after each dose, then q 4 hrs. Temperature q 4 hrs if membranes intact, q 2 hrs if membranes ruptured.
7. If patient progresses into labor, initiate LDR pathway (initiate order set form # 9044)
8. If OSA score ≥ 75 or pt history of OSA, initiate OSA in Pregnancy Orders (form # 32839). Vaccination screening (form # 26423).
MEDICATIONS (SELECT ONE):
9. q Cytotec (misoprostol) 25 mcg intravaginally q 4 hrs prn cervical ripening up to 6 doses
q Cytotec (misoprostol) 25 mcg po q 4 hrs prn cervical ripening up to 6 doses
q Cytotec (misoprostol) 25 mcg po x 1 dose, then 4 hours later begin 50 mcg po q 6 hrs prn cervical ripening up to 4 doses
Hold dose for 2 hrs following rupture of membranes.
Hold dose if patient having 2 or more contractions in 10 min, averaged over a 30 min period or cervix dilated > 3 cm.
q Cervidil (dinoprostone) 10 mg intravaginally × 1 dose
10. In the event of uterine tachysystole or a tetanic uterine contraction with a Category II or III FHR tracing, give terbutaline 0.25 mg SQ × 1 dose and notify Physician/CNM. Attempt retrieval of the tablet or Cervidil (dinprostone) if possible.
11. Upon Physician/CNM order, IV Pitocin (oxytocin) may be initiated, use Pitocin (oxytocin) preprinted orders (form # 6):
· A minimum of 4 hrs after the last dose of Cytotec (misoprostol)
· A minimum of 30 - 60 min after Cervidil (dinoprostone) removal
______
Date Time Physician Signature PID Number
Copy to pharmacy
*1-9045* FORM 1-9045 REV. 04/2014 Page 1 of 1