* This data relates to a direct comparison between Prostin^® gel and Dinoprostone. A direct comparison between Prostin^® tablets and Dinoprostone is not available for oxytocin augmentation.

Q1. References

1. Nice induction of labour https://www.nhs.uk/planners/pregnancycareplanner/documents/nice_induction_of_labour.pdf (Last viewed: 18/10/21)

2. Ferring Pharmaceuticals Prostin Gel SPC Feb 2018 https://www.medicines.org.uk/EMC/medicine/1562/SPC/Prostin+E2+Vaginal+Gel+1mg,+2mg/ (Access last: 18/10/21)

3. Ferring Pharmaceuticals Prostin Tablets SPC Feb 2018 https://www.medicines.org.uk/EMC/medicine/1563/SPC/Prostin+E2+Vaginal+Tablets/ (Access last: 18/10/21)

4. Kelly AJ, Malik S, Smith L, Kavanagh J, Thomas J. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. Cochrane Database of Systematic Reviews 2009, Issue 4. https://www.cochrane.org/CD003101/PREG_vaginal-prostaglandin-pge2-and-pgf2a-for-induction-of-labour-at-term (Last viewed: 18/10/21)

• Well tolerated^1,3
• 3-year follow up: no adverse consequences on child health or development.²
• Can be used with caution in women presenting with ruptured membranes (should be removed if membranes rupture while Propess is in place). Since the release of dinoprostone from the insert can be affected by the presence of amniotic fluid, continuous monitoring of uterine and foetal condition is recommended.

References

1. Lyrenas Sven et al. BJOG 2001;108:169-178.

2. MacKenzie I and McKinlay E (1995). Paediatric follow-up study: Follow-up of infants delivered by spontaneous vaginal delivery, following prostaglandin E2 or oxytocin induction by caesarean section. In: Propess RS – A Clinical Review. Calder A, Keirse M and Mackenzie I (Eds). Euromed Communications Ltd. England.

3. Westgate J and Williams J.A. Journal of Obstetrics and Gynaecology 1994;14:146-150.

• Dinoprostone should only be administered by qualified healthcare professionals in hospitals and clinics with specialised obstetric units where facilities for continuous foetal and uterine monitoring are available.
• The condition of the cervix should be assessed carefully before dinoprostone is used.
• After insertion, uterine activity and foetal condition must be carefully monitored.
• Please refer to:
  • NICE clinical guideline 190 for Intrapartum care: care of healthy women and their babies during childbirth. Updated: December 2022. Section 1.10 https://www.nice.org.uk/guidance/cg190
  • NICE clinical guideline (2021) for Induction of labour. https://www.nice.org.uk/guidance/ng207

References

Dinoprostone Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/135. Accessed December 2023.

A dosing interval of at least 30 minutes is recommended for the sequential use of oxytocin following the removal of the vaginal delivery system.

References

Dinoprostone Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/135. Accessed December 2023.

A second dose of dinoprostone is not recommended, as the effects of a second dose have not been studied.

References

Dinoprostone Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/135. Accessed December 2023.

Dinoprostone has a half-life generally estimated as 1-3 minutes.

References

Dinoprostone Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/135. Accessed December 2023.

Yes, dinoprostone can be used in presence of ruptured membranes with caution. Since the release of dinoprostone from the insert can be affected by the presence of amniotic fluid, special attention should be given to uterine activity and foetal condition.

References

Dinoprostone Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/135. Accessed December 2023.

No, dinoprostone is contraindicated in women who have had previous major uterine surgery e.g. caesarean section.

References

Dinoprostone Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/135. Accessed December 2023.

Storage and shelf life for dinoprostone is as follows:

Shelf-life: 3 years

Storage: Store in a freezer. Store in the original container in order to protect from moisture.

Instructions for use: Dinoprostone should be removed from the freezer just prior to insertion.

References

Dinoprostone Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/135. Accessed December 2023.

If the dinoprostone insert falls out, you may insert a new insert, if required, to make up for the remainder of the 24 hour time period.

How to minimise risk of insert falling out:

• If you experience the dinoprostone insert falling out then a slight modification in the insertion technique should ensure a quick resolution of the problem.
• The patient should remain in bed for 30 minutes after insertion but may be ambulatory thereafter.
• Informing the patient prior to insertion may also minimise the chances of the dinoprostone insert falling out.
• The woman should take extra care not to pull the insert out accidentally when going to the bathroom.

• There is no evidence to suggest that women cannot bathe or shower whilst the dinoprostone is inserted.
• Women should take care not to pull the retrieval tape as this may dislodge the insert and it may fall out.
• The release of the drug is controlled by polymer thickness, therefore even if the polymer has swollen very quickly to its maximum, it will still control the release of the drug.