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Prostaglandin E2 (Cervical Ripening / Induction of Labour) Pregnancy: Indicated at term for induction — not for use in preterm labour induction (except specific indications)

Dinoprostone (Cervical Ripening / Induction of Labour)

Brand names: Prostin E2 (3 mg pessary), Propess (10 mg sustained-release pessary)

Adult dose

Dose: Prostin E2 3 mg pessary: insert vaginally; repeat after 6–8h if required (max 2 doses = 6 mg). Propess 10 mg sustained-release: insert vaginally; remove after 24h or at onset of active labour
Route: Vaginal pessary
Frequency: Prostin: up to 2 doses; Propess: single 24h insertion
Max: 6 mg total (Prostin); 10 mg (Propess single device)
Propess preferred in many units: slow-release over 24h, retrieval string allows removal if hyperstimulation occurs. Monitor CTG for 30 min after insertion. NICE NG207: IOL with dinoprostone or misoprostol as standard. ARM + oxytocin if Bishop score ≥6 after ripening.

Paediatric dose

Route: N/A
Frequency: N/A
Max: N/A
Not applicable in paediatric patients

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Clinical pearls

  • Propess retrieval string: in hyperstimulation, removing the pessary rapidly reduces the prostaglandin dose — this is a key safety advantage over Prostin
  • Do NOT use dinoprostone in women with previous CS without full counselling and consultant review — risk of uterine rupture
  • CTG monitoring: continuous for 30 min after insertion; intermittent monitoring thereafter per local protocol
  • Oxytocin timing: wait minimum 30 min after Propess removal (or 6h after Prostin) before commencing oxytocin
  • NICE NG207 (2021 IOL guidelines): dinoprostone and misoprostol both acceptable; choice per local protocol

Contraindications

  • Previous uterine scar (CS or myomectomy) — relative contraindication (higher rupture risk); discuss risk
  • Fetal distress (abnormal CTG)
  • Active labour
  • Unexplained antepartum haemorrhage
  • Grand multiparity (≥5 previous births)
  • Placenta praevia

Side effects

  • Uterine hyperstimulation (most serious — remove Propess retrieval string immediately)
  • Fetal distress (secondary to hyperstimulation)
  • GI upset
  • Fever
  • Local vaginal discomfort

Interactions

  • Oxytocin — do NOT commence within 6h of Prostin or after Propess removal (additive uterotonic risk)
  • NSAIDs — may reduce prostaglandin efficacy

Monitoring

  • CTG (continuous 30 min post-insertion; then per protocol)
  • Uterine contraction frequency (hyperstimulation watch)
  • Bishop score progression
  • Fetal and maternal wellbeing

Reference: BNFc; NICE NG207 Inducing Labour (2021); RCOG IOL Guideline; BNF. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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