Propess versus Prostin: There is an alternative way to induce labour

Abstract

Background Following a shortage of Prostin gel in 2015, an alternative method of inducing labour was required. The Propess® pessary was sourced, a guideline adapted for local use and the method introduced into the local unit. There was a perception that this means of induction took longer than the traditional Prostin but with a higher vaginal birth rate. Aims To evaluate the effectiveness and safety of Propess® as a method of induction compared with Prostin. Methods A retrospective audit to compare the labour and mode of birth of all women who were induced in the Directorate over a specific time period. The NICE Clinical Guideline no. 70 (2008) was used as the audit standard. Findings Only 28.5% women in the Propess® group required the use of oxytocin to artificially initiate contractions, versus 43% in the Prostin group. The Prostin group took slightly longer overall from the start of the induction process to the birth of the baby. There was a similar vaginal birth rate in both groups and similar clinical outcomes for the babies. Conclusions Propess® is a safe, effective means to induce labour with its use to be continued locally. Results have been disseminated within the wider hospital group and a new audit planned for 2017.

Outpatient versus inpatient cervical ripening with a slow‐release dinoprostone vaginal insert in term pregnancies on maternal, neonatal, and birth outcomes: A systematic review

“…24,25 An array of synthetic prostaglandin formulations has been used to induce labor since their inception in 1960 as they are safe, easy to administer and well tolerated by women. 2,6,26 The slow-release dinoprostone vaginal insert (hereinafter referred to as dinoprostone insert) is a relatively recent prostaglandin formulation to obstetric practice and it appears to be the most suitable prostaglandin agent for the outpatient setting. This formulation has been used in Ireland as an alternative method for cervical ripening after a global shortage in 2015 of the widely used prostaglandin gel.…”

“…This formulation has been used in Ireland as an alternative method for cervical ripening after a global shortage in 2015 of the widely used prostaglandin gel. 26 Although both the prostaglandin gel and the dinoprostone insert are shown to be equally effective in achieving cervical ripening, only the latter was considered in this systematic review for its characteristics of being retrievable, as it can be easily removed by merely pulling on the string attached to it, slow-release (releases 0.3 mg of prostaglandin per hour for 24 h when inserted in the posterior vaginal fornix), predictable in terms of uterine hyperstimulation, reversible and more accepted by women. 26 Despite the evidence that supports outpatient IOL, currently just one maternity unit in Ireland is offering this service to healthy women with term uncomplicated pregnancies undergoing IOL.…”

“…The slow‐release dinoprostone vaginal insert (hereinafter referred to as dinoprostone insert) is a relatively recent prostaglandin formulation to obstetric practice and it appears to be the most suitable prostaglandin agent for the outpatient setting. This formulation has been used in Ireland as an alternative method for cervical ripening after a global shortage in 2015 of the widely used prostaglandin gel 26 . Although both the prostaglandin gel and the dinoprostone insert are shown to be equally effective in achieving cervical ripening, only the latter was considered in this systematic review for its characteristics of being retrievable, as it can be easily removed by merely pulling on the string attached to it, slow‐release (releases 0.3 mg of prostaglandin per hour for 24 h when inserted in the posterior vaginal fornix), predictable in terms of uterine hyperstimulation, reversible and more accepted by women 26 …”