dinoprostone: clinical use

Prescribing considerations

• Restrict use to appropriately staffed specialist obstetric settings with facilities for maternal, uterine and fetal assessment.
• Assess cervical status, presentation, cephalopelvic relationship, uterine-surgery history and current maternal and fetal condition before treatment.
• Use caution with asthma, epilepsy, glaucoma or raised intraocular pressure, hypertension, organ dysfunction, ruptured membranes, multiple pregnancy or previous uterine hypertonus.
• Consider the increased postpartum disseminated intravascular coagulation risk associated with older maternal age, pregnancy complications and prolonged gestation.

Contraindications and cautions

• Hypersensitivity to dinoprostone, prostaglandins or formulation excipients.
• Previous caesarean section or major uterine surgery where strong or prolonged contractions would be inappropriate; wording and status vary by product.
• Placenta praevia, unexplained antepartum bleeding, fetal malpresentation, cephalopelvic disproportion or suspected fetal distress, as applicable to the formulation.
• Current pelvic inflammatory disease unless adequately treated.
• Concurrent oxytocic or other labour-induction treatment for the removable vaginal delivery system.
• Active cardiac, pulmonary, renal or hepatic disease for the selected Prostin formulations.

Monitoring

• Monitor uterine activity and fetal condition carefully and regularly during labour induction.
• Remove the vaginal delivery system or stop intravenous administration promptly if hyperstimulation, hypertonus, fetal distress or significant maternal adverse effects develop.
• After delivery, remain alert for bleeding and early evidence of disseminated intravascular coagulation in higher-risk patients.

Clinical pharmacology

Dinoprostone is prostaglandin E2. It promotes cervical ripening and myometrial contraction and is rapidly metabolised locally and systemically.

Formulation and product differences

• The vaginal delivery system provides controlled release and can be removed using its retrieval tape.
• Vaginal tablets and gel are administered into the posterior vaginal fornix; the gel and tablet formulations are not bioequivalent.
• The selected intravenous product is an ethanol-containing concentrate that requires dilution and controlled infusion.
• Formulations are not interchangeable; contraindications, removal options and instructions differ.

Vaginal gel

Route: Vaginal

Strengths: 1 mg, 2 mg