Cervidil Vaginal Tape (Dinoprostone, PGE2)

Last updated 08.03.13

   

Definition

-  Prostaglandin tape used to promote cervical ripening (softening & effacement) & stimulate myometrial contractions during pregnancy

 

Features

-  Used for IOL

-  Cervical ripening

-  Stimulation of labour & contractions

- Can be easily removed if hyperstimulation

- Used as an alternative to Prostin

 

Indications

-  Bishop score 5 or less: cervical ripening

-  IOL during pregnancy

 

Dose

-  Dinoprostone 4mg released over 12hrs

 

Contraindications

-  Spontaneous labour

-  Abnormal CTG or known fetal compromise

-  Persistant maternal fever

-  Vaginal bleeding

-  Transverse or oblique lie of foetus

-  Existing contraindications to vaginal delivery

-  VBAC

 

Cautions

-  To avoid uterine hyperstimulation

-  Oxytocin not used within 30min of Cervadil

-  Careful use in

-  Previous uterine hyperstimulation

-  Previous LUSCS

-  Ruptured membranes

-  HTN

-  Mobile presenting part

-  Asthma

-  Cardiac disease

-  Multiple pregnancy: twins..

 

Procedure

- Remove from freezer immediately prior to use (does not need to be warmed)

- Normal CTG within 6hrs of application

-  Typically for 30min+

-  VE with Bishop score 5 or less

-  Cervadil inserted to posterior fornix (NOT cervix)

-  Small amount of water soluble lubricant if needed

-  Done at time of VE

- Ensure enough tape remains to remove when needed

- Use scissors to cut tape short (do not try and tuck in tape)

-  Patient to remain recumbent & lateral for 30min+

-  CTG for 30min+ post insertion

-  Continuous CTG if

-  FHR abnormal

-  Established labour

-  Uterine activity

-  SROM

-  Every 4hrs+/- repeat CTG (even if overnight)

-  12hrs remove and repeat VE

-  ARM if able + Syntocinon at least 30min after removal

-  If unfavourable induction failed

- Cannot use additional doses

 

Cervadil

 

Complications

-  Uterine hyperstimulation

-  Abnormal CTG

-  Placental abruption

-  Uterine rupture

-  GIT disturbance: nausea, vomiting, diarrhoea (2% pts)

-  Vaginal irritation

-  Postpartum haemorrhage

-  Amniotic fluid embolism

 

 

References

 

Cervadil product information