Queensland Health Prostaglandin E2 (dinoprostone) for induction of labour Induction of labour Prostaglandin E2 (dinoprostone) See flowchart: Method of induction Indications Pre dinoprostone insertion · Unfavourable cervix (MBS ≤ 6) · Complete pre IOL assessment · Following balloon catheter if no/ · Encourage to empty bladder minimal effect on cervical ripening and ARM not technically possible Contraindications · Known hypersensitivity · Ruptured membranes · Multiparity ≥ 5 Dinoprostone GEL Dinoprostone PESSARY · Previous CS or uterine surgery · Nulliparous: 2 mg PV · 10 mg PV · Malpresentation/high presenting · Multiparous: 1 mg PV · Position transversely in part · Insert high into posterior posterior fornix · Undiagnosed PV bleeding fornix · Wait at least 12 hours after · Abnormal CTG/fetal compromise · Wait at least 6 hours after insertion then reassess insertion then reassess Cautions MBS MBS · Multiple pregnancy · Asthma, chronic obstructive pulmonary disease: may cause bronchospasm [email protected] · Epilepsy · Cardiovascular disease Recommend ARM · Raised intraocular pressure, irrespective of MBS glaucoma · Avoid concurrent oxytocin use Post dose care Queensland Clinical Guidelines, Guidelines, Clinical Queensland ARM Yes · TPR, BP, FHR, uterine activity, successful? PV loss hourly for 4 hours or SROM? · CTG for minimum of 30 minutes · If observations normal, no No 8 contractions and not otherwise nd/3.0/au/deed.en - nc indicated, ongoing care as for - latent first stage of labour · Continuous CTG when in active If GEL used: labour or when contractions are · May repeat to maximum of 3 If PESSARY used: ≥ 3 in 10 minutes doses at least 6 hours apart · Give one dose of · After insertion advise woman to: o Nulliparous 2 mg dinoprostone GEL Remain recumbent for 30 o o Multiparous 1–2 mg · Wait at least 6 hours then minutes · Wait at least 6 hours then reassess MBS o Inform staff as soon as reassess MBS contractions commence State of Queensland (Queensland Health) 201 Health) (Queensland Queensland of State http://creativecommons.org/licenses/by PESSARY removal indications · Onset of regular, painful uterine contractions, occurring every 3 minutes regardless of cervical change No ARM Yes · Ruptured membranes successful? or SROM? · Fetal distress · Uterine hyperstimulation or hypertonic uterine contractions · Maternal systemic adverse effects (e.g. nausea, vomiting, Recommend oxytocin hypotension, tachycardia) Consider balloon · 6 hours after GEL · Insufficient cervical ripening after catheter · 30 minutes after removal 24 hours of PESSARY (minimum) ARM: Artificial rupture of membranes; BP: Blood pressure; CS: Caesarean section; CTG: Cardiotocography; FHR: Fetal heart rate; IOL: Induction of labour; MBS: Modified Bishop Score; PV: Per vaginam; SROM: spontaneous rupture of membranes; TPR: Temperature, pulse and respirations; ≥: greater than or equal to; ≤: less than or equal to Queensland Clinical Guideline: Induction of labour. Flowchart: F17.22-3-V6-R22 Queensland Clinical Guidelines www.health.qld.gov.au/qcg .