Midwives may administer this drug after consulting with and on the order of a physician.
In pregnancy, prostaglandins E2 (PGE2) are secreted by the fetal membranes and placenta. They are believed to play an important role in cervical ripening and the initiation of labour by stimulating the production of prostaglandin F2Alpha (PGF2α) which increases the sensitivity and number of oxytocin receptors on the myometrium.
Dinoprostone is a synthetic analogue of PGE2. Vaginal preparations of Dinoprostone (PGE2 gels and vaginal inserts, including sustained release preparations), appear to be effective in cervical ripening and induction of labour.
Indications and Clinical Use:
Dinoprostone is primarily used as an in-hospital method of ripening the cervix in preparation for labour or in the presence of a medical or obstetrical indication for the induction of labour.
Known hypersensitivity to prostaglandins, any condition that preclude labour and vaginal birth, abnormal fetal status, non-vertex presentation, history of previous cesarean section or major uterine surgery, unexplained vaginal bleeding in pregnancy, >5 term pregnancies, history of epilepsy (Prepidil only) and concurrent use of oxytocic drugs.
Warnings and Precautions:
Dinoprostone may be used in the presence of rupture of membranes (ROM). However, there may be an increase in chorioamnionitis when vaginal prostaglandins are used for induction with ruptured membranes when compared with oxytocin induction.
First 28 weeks of pregnancy – Contraindicated unless for termination/evacuation. Pregnancy near or at term – Compatible.
Category L3 – No Data – Probably Compatible (but will be well-metabolized before lactogenesis)
Hypotension, syncope, tachycardia, dizziness, hyperthermia, nausea, vomiting, diarrhea, tachysystole, hypertonus, hyperstimulation, abnormal fetal heart rate.
Dosage and Administration:
|Cervidil © Ferring|
|Time release polymer wafer||intravaginal||10mg with slow release of 0.3 mg / hr||Repeat in 12-24 hours; remove at the onset of active labour|
|Prepidil © Pfizer|
|Gel||endocervix||0.5 mg / 2.5 ml (3 gm)|
|Repeat every 6 hours max dose 3x in 24 hrs|
|Prostin E2 © Pfizer|
|Gel||intravaginal||1mg / 3 grams|
2mg / 3 grams
|Repeat in 6 hrs|
Onset of Action:
Time to peak: 0.5-1 hour