21. Principles of drug administration
administration of medicines per vaginam
CHAPTER CONTENTS
Role and responsibilities of the midwife156
Summary157
Self-assessment exercises157
Reference157
LEARNING OUTCOMES
Having read this chapter the reader should be able to:
• describe how a drug is administered P.V.
• discuss the role and responsibilities of the midwife before, during and after administration
• list the factors that are pertinent to the administration of prostaglandin P.V.
The midwife is actively involved in the administration of medicines per vaginam (P.V.), largely with prostaglandin for the induction of labour. Placing a drug into the vagina is a means of ensuring that the action of the drug can work directly (locally) to produce the desired effect. Other drugs may also be administered P.V. (e.g. antifungal preparations). This chapter considers the midwife’s role and responsibilities and the procedure for administration P.V., focusing largely on the administration of prostaglandin E 2 (PGE 2).
Per vaginam administration
This is generally an embarrassing route for medication administration. Care should be taken that informed consent has been granted and that efforts are made to protect dignity and privacy. Some P.V. medications could often be administered by the woman herself. If the need arose, it is sometimes possible to remove a vaginal tablet or pessary but this is an unreliable action and so should not be factored in as a possibility. The midwife should maintain asepsis, particularly if the membranes have ruptured, and use personal protective equipment as indicated.
Using prostaglandin
In its Induction of Labour (IOL) guideline, the National Institute for Health and Clinical Excellence (NICE 2008) is clear about the following points:
• Care should be woman-centred with the woman able to make an informed decision, being particularly aware of the risk of uterine hyperstimulation.
• The wellbeing of the fetus should be confirmed prior to PGE 2 administration.
• The venue and timing of the administration should permit electronic fetal assessment. The morning is often the best time. If prostaglandin is given as an outpatient, instruction must accompany the woman as to the need to when to contact the maternity services: after 6 hours if no signs of labour or earlier if contractions begin. The Bishop’s score should be reassessed 6 hours after the PGE 2 administration.
