June 30th, 2022

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Inducing Labor with a Sustained-Release PGE2 Vaginal Insert: Experience at a Community Hospital
Authors:  Fred C. Blair, M.D., Shawn A. Tassone, M.D., Carla R. Pearman, M.D., Mark B. St. Cyr, R.Ph., M.P.H., and William F. Rayburn, M.D.
  OBJECTIVE: To determine the safety of initiating labor
using a sustained-release prostaglandin E2 (PGE2) vaginal
insert at a nonuniversity-based community hospital.

were compiled from a chart
review of all cases in which
the insert (Cervidil) was
used during a 16-month period.
Continuous uterine activity
and fetal heart rate
(FHR) tracings were evaluated
for 12 hours after dosing.
The onset of regular uterine contractions or of active
labor and the reason for any premature removal of the insert
were sought.

RESULTS: Regular contractions ensued in 62 (35.8%)
of 173 pregnancies. Primary reasons for removal of the
insert in 59 (34.1%) cases were active labor (38), ruptured
membranes (11), uterine hyperstimulation (7) and
a nonreassuring FHR tracing. The average time from insertion
until premature removal was 5.7 1.3 (SD)
hours (95% confidence interval, 3.3-8.2). The insert fell
out in nine (5.2%) cases. Cesarean delivery for failed
labor induction was necessary in five (2.9%) cases. All
immediate neonatal outcomes were reassuring. Following
inservice training, nurses were capable of inserting
and removing the insert.

CONCLUSION: This PGE2 vaginal insert, administered
and removed by attending nurses, is associated
with very low rates of uterine hyperstimulation and
failed induction. Premature removal of the insert occurred
in 34.1% of cases. (J Reprod Med 1998;43:
Keywords:  labor, induced; prostaglandin E2; dinoprostone
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