title: Dinoprostone vaginal pessary for induction of labour: safety of use for up to 24 h.
abstract: BACKGROUND
  Cervidil(®) (dinoprostone) intravaginal pessaries are used for induction of labour and maintain serum prostaglandin levels for up to 24 h. The Therapeutic Goods Administration approves Cervidil(®) for 12-h use. However, twenty-four-hour use of Cervidil(®) is supported in Europe, New Zealand, America and some Australian hospitals.
  
  
  OBJECTIVE
  To assess the safety of Cervidil(®) use for up to 24 h for induction of labour in nulliparous women.
  
  
  METHODS
  A retrospective cohort study of 269 consecutive women receiving Cervidil(®) at the Royal Brisbane and Women's Hospital (RBWH) between July 2007 and December 2008 was performed. The primary outcome measures were frequency of, and time to, uterine tachysystole with or without fetal heart rate (FHR) changes. Secondary outcome measures included frequency of maternal (intrapartum temperature, postpartum haemorrhage) and neonatal (low Apgars, resuscitation, nursery admission) morbidity. Morbidity outcomes of those who received Cervidil(®) for less than or equal to 12 h were compared with those who received Cervidil(®) for more than 12 h.
  
  
  RESULTS
  Uterine tachysystole occurred in 9.3% of patients receiving Cervidil(®) , with a mean time to tachysystole of 10 h. The majority of cases (68%) occurred within 12 h of use. There was no increase in maternal or neonatal morbidity for those who received Cervidil(®) for longer than 12 h.
  
  
  CONCLUSIONS
  Twenty-four-hour use of Cervidil(®) is likely as safe as 12-h use for induction of labour in nulliparous women.
authors.affiliation: Royal Brisbane & Women's Hospital - Women's and Newborn Services, Brisbane, Queensland, Australia.
authors.forename: Kellie
authors.initials: K
authors.lastname: Tathem
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Harris
authors.forename: Peter
authors.initials: P
authors.lastname: O'Rourke
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Kimble
mesh_terms: D000328:Adult; D001034:Apgar Score; D015232:Dinoprostone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000139:chemically induced; D006340:Heart Rate, Fetal / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D053208:Kaplan-Meier Estimate; D007751:Labor, Induced / Q000379:methods*; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects*; D010298:Parity; D010570:Pessaries; D006473:Postpartum Hemorrhage / Q000139:chemically induced; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D014590:Uterine Contraction / Q000187:drug effects
chemical_list: D010120:Oxytocics; D015232:Dinoprostone