Propess versus Prostin: There is an alternative way to induce labour
Following a shortage of Prostin gel in 2015, an alternative method of inducing labour was required. The Propess® pessary was sourced, a guideline adapted for local use and the method introduced into the local unit. There was a perception that this means of induction took longer than the traditional Prostin but with a higher vaginal birth rate.
To evaluate the effectiveness and safety of Propess® as a method of induction compared with Prostin.
A retrospective audit to compare the labour and mode of birth of all women who were induced in the Directorate over a specific time period. The NICE Clinical Guideline no. 70 (2008) was used as the audit standard.
Only 28.5% women in the Propess® group required the use of oxytocin to artificially initiate contractions, versus 43% in the Prostin group. The Prostin group took slightly longer overall from the start of the induction process to the birth of the baby. There was a similar vaginal birth rate in both groups and similar clinical outcomes for the babies.
Propess® is a safe, effective means to induce labour with its use to be continued locally. Results have been disseminated within the wider hospital group and a new audit planned for 2017.
Induction of labour is a relatively common procedure worldwide, which is used for approximately 20% of pregnancies (NICE 2008). For over 50 years, prostaglandins have been the pharmaceutical method of choice to stimulate labour (Ayaz et al, 2013). Prostaglandins are used to artificially ripen the cervix, thus increasing the chance of labour occurring (Kalkat et al, 2008). The Propess® (a slow-release pessary) method of induction involves a pessary being inserted for 24 hours with the Prostin vaginal gel induction, involves 6 hourly administrations with repeat doses as required and directed by the induction of labour clinical guideline (NICE, 2008). Approximately two thirds of inductions will only require prostaglandins with no further interventions. There is no specific discussion of oxytocin usage following induction in this guideline or other international guidance documents. Following induction of labour, 15% will have an instrumental delivery with around 22% requiring a caesarean section (NICE, 2008). None of the national clinical guidelines report oxytocin augmentation rates specific to different preparations and doses of prostaglandins.
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