Prostaglandins - in induction of labor

Prostaglandins for induction of labor :
Prostaglandins act on cervix to enable ripening there by initiating labor.
This can be caused by dilatating of smooth vessels in cervix, increasing collagen degradation, increasing hyaluronic acid, elastase, glycosaminoglycons.
And also by increasing chemotaxis for leukocytes, stimulation of IL- 8 and increasing the intracellular cal levels.
Different forms of prostaglandins can be used for induction of labor like,
Dinoprostone gel:

For placement of dinoprostone gel for induction of labor, patient should be selected carefully.
Patient should be afebrile with no active vaginal bleeding.
And FHR tracing should be reassuring.
Informed written consent should be given by the patient.
Bishop score(a score which indicates the status of cervical ripening) should be < 4.
We have to bring the gel to room temperature before insertion.
FHR monitoring and uterine activity should be monitored continuously from 15 to 30 min before insertion to 30 to 120 min after gel insertion.
For uneffaced cervix, 20 mm endocervical catheter should be used to introduce the gel into endocervix just below the level of the internal os.
In case of 50% effaced cervix, 10 mm endocervical catheter can be used.
Patient should remain in recumbent position for 30 min to prevent spillage of gel.
Dose may be repeated every 6 hrs, up to 3 doses in 24 hrs.
End point for ripening is, establishment of strong uterine contractions, or achieving Bishop score >/ 8, or change in maternal or fetal status.
Maximum dose of dinoprostone gel is 1.5 mg in 24 hrs.
After gel insertion should not start oxytocin for 6 to 12 hrs to protect from overstimulation.
Side effects: hyper stimulation, nausea, vomiting, diarrhea, fever etc.

Prostaglandins-types
Prostaglandin-routes of administration
Prostaglandins-in inducing abortions
Cervidril, misoprostol
Prostaglandins- in PPH, uterine atony