Dinoprostone (Cervical Ripening / Induction of Labour)

How it works

Acting on prostaglandin receptors, it softens and effaces the cervix and stimulates myometrial contractions, promoting the onset of labour.

Prescribing in practice

• Continuous monitoring of uterine activity and fetal wellbeing is essential because of the risk of uterine hyperstimulation, which can cause fetal compromise; have facilities to remove a vaginal insert and manage hyperstimulation available.
• Use with caution and weigh the risks in women with a uterine scar, such as previous caesarean section, owing to the risk of uterine rupture.
• Avoid concurrent administration with oxytocin and observe a recommended interval before starting oxytocin, as effects are additive.

Monitoring

Continuously monitor uterine contractions and the fetal heart rate throughout administration and after removal of any controlled-release insert.

Counselling the patient

• Explain that the medicine is used to help start or progress labour and that contractions and some discomfort are expected.
• Report severe or very frequent contractions promptly to staff.
• You will be closely monitored, including the baby's heart rate, during the process.

Evidence & guidelines

Vaginal dinoprostone (PGE2) is recommended in NICE guidance on inducing labour as a preferred pharmacological method for cervical ripening.