First-linePropess / Prostin
Dinoprostone (PGE2)
Prostaglandin E2
Cervical ripening / IOL — Propess pessary.
Vaginal pessaryVaginal gel/tablet
First-line for
- Induction of labour (Bishop <6)
- Cervical ripening
Mechanism
PGE2 → cervical collagenolysis + myometrial contractility.
Propess
- 10 mg slow-release over 24 h
- Remove if hyperstim / SROM / labour
Dosing
- Propess
- 10 mg vaginal insert ×24 h
- Prostin gel
- 1–2 mg PV, repeat after 6 h (max 4 mg/3 mg)
Contraindications
- AbsolutePrevious caesarean (uterine rupture)
- AbsoluteActive asthma, pelvic infection, placenta praevia
Side effects
- Uterine hyperstimulation
- GI upset, fever
- Fetal distress
Fetal & maternal notes
- • Continuous CTG once contracting.
- • Tocolysis (terbutaline) if hyperstim.
Key interactions
Oxytocin
CautionWait ≥6 h after removal before syntocinon
Clinical pearls
- 💡 Bishop ≥7 → ARM ± syntocinon instead.
- 💡 Counsel risks of failed IOL → LSCS.
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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