Prostaglandins - in inducing labor- cervidil, misoprostol

Cervidil:
It is a device containing dinoprostone, with a small amount of water- miscible lubricant, should be placed in the post fornix of vagina.

The devise absorbs moisture and swells, releases dinoprostone at a rate of 0.3 mg per hour for 12hrs.
FHR(fetal heart rate) monitoring should be done from 15 to 30 min before placement to 15 min after removal.
Patient should remain recumbent for 2 hrs after keeping the device in place to prevent falling of device.
 The device can be removed by pulling the cord attached to it after 12 hrs or when active labor begins, or if uterine hyperstimulation occurs.

Misoprostol :
Misoprostol is a synthetic PGE1 analog.

Can be used as:
- 25 micrograms tablet form intravaginally, repeated every 4 to 6 hrs
- or orally 50 – 100 micro g tablet , to be repeated every 4 hrs.
During induction of labor misoprostol can be placed as 25 micro g tablet, intravaginally without the use of any gel.
Patient should remain in recumbent position for 30 min to prevent falling of tablet.
FHR monitoring should be done for 3 hrs.
Oxytocin augmentation can be done after 3 hrs if needed.
Side effects:
Hyper stimulation syndrome:
contraction for 90 sec or more and 5 contractions or more in 10 min.
 Tachysystole :
Six or more uterine contractions in 10 min for two consecutive 10 min period.
Hypersystole:
a single contraction of at least two minutes duration.
Misoprostol should not be used in women with uterine scars, as chances of rupture of uterus are there.

Prostaglandins-types
Prostaglandin-routes of administration
Prostaglandins-in inducing abortions
Prostaglandins-induction of labor
Prostaglandins- in PPH, uterine atony