* This data relates to a direct comparison between Prostin gel and Propess. A direct comparison between Prostin tablets and Propess 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)

• Reduction in the use of oxytocin augmentation with Propess compared with PGE2 gel (23.3% versus 41.3%; RR 0.55, 95% CI 0.35 to 0.88; two RCTs)¹
• Well tolerated^2,4
• 3 year follow up: no adverse consequences on child health or development³
• Can be used with caution in women presenting with PROM (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 fetal condition is recommend.

Q2. References

1. Nice induction of labour https://www.nhs.uk/planners/pregnancycareplanner/documents/nice_induction_of_labour.pdf (last viewed:18/10/21)
2. Lyrenas Sven et al., In vivo controlled release of PGE2 from a vaginal insert (0.8mm, 10mg) during induction of labour, BJOG, February 2001, Vol. 108, pp169-178
3. IZ MacKenzie and E McKinley – Paediatric follow up study (Last accessed-18/10/21)
4. Westgate J & Williams J.A. Evaluation of a controlled release vaginal prostaglandin E2 pessary with a retrieval system for the induction of labour. Journal of Obstet and Gynaecol (1994), Vol 14, Issue 3 May, 146-150

• Propess should only be administered by qualified healthcare professionals in hospitals and clinics with specialised obstetric units where facilities for continuous fetal and uterine monitoring are available.
• The condition of the cervix should be assessed carefully before Propess 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. Issued: December 2014. Section 1.10 https://www.nice.org.uk/guidance/cg190
• NICE clinical guideline (2021) for Induction of labour. Section 7.1 https://www.nice.org.uk/guidance/cg70

Q3. References
Ferring Pharmaceuticals. Propess Summary of Product Characteristics. October 2021 https://www.medicines.org.uk/emc/product/135 last viewed on 18/10/21

The use of oxytocin is recommended after at least a 30 minute waiting period following the removal of Propess.

Q4. References
Ferring Pharmaceuticals. Propess Summary of Product Characteristics. October 2021 https://www.medicines.org.uk/emc/product/135  last viewed on 18/10/21

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

Q5. References
Ferring Pharmaceuticals. Propess Summary of Product Characteristics. October 2021 https://www.medicines.org.uk/emc/product/135 last viewed on 18/10/21

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

Q6. References
Ferring Pharmaceuticals. Propess Summary of Product Characteristics. October 2021 https://www.medicines.org.uk/emc/product/135 last viewed on 18/10/21

Yes, Propess 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 fetal condition.

Q7. References
Ferring Pharmaceuticals. Propess Summary of Product Characteristics. October 2021 https://www.medicines.org.uk/emc/product/135 last viewed on 18/10/21

No, Propess is contraindicated when there is suspicion or evidence of uterine scar resulting from previous uterine or cervical surgery, e.g. Caesarean delivery.

Q7. References
Ferring Pharmaceuticals. Propess Summary of Product Characteristics. October 2021 https://www.medicines.org.uk/emc/product/135 last viewed on 18/10/21

Storage and shelf life for Propess 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: Propess should be removed from the freezer in direct connection with insertion.

Q8. References
Ferring Pharmaceuticals. Propess Summary of Product Characteristics. October 2021 https://www.medicines.org.uk/emc/product/135 last viewed on 18/10/21

• If the Propess 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 Propess 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 Propess 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 Propess 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.