Obstetrics and Gynaecology
Used by women who have a normal pregnancy and are near their due date for delivery to prepare for induction.
Remember that this sheet does not give you all of the information about CERVIDIL and cervical ripening. If you have any concerns or other questions about CERVIDIL ask your LMC (Lead Maternity Caregiver – Doctor or Midwife). What is an Induction?
An Induction is the process of starting labour artificially instead of waiting for it to occur naturally. An induction will only be commenced if there is a compelling medical reason to do so as there are increased risks with assisted and caesarean section deliveries. Your Lead Maternity Carer (Doctor or Midwife) will discuss this with you and your Family/ Whanau and can answer any questions that you may have. Inductions are recommended when the health of the mother and/or baby will benefit. Why do I need to be Induced?
Some babies may need to be delivered before labour starts spontaneously. Common reasons for inductions include High Blood Pressure, Diabetes, Bleeding as well as problems with the baby or because they are overdue. The reason you are being recommended for Induction will be discussed with you and your consent sought. How will I be Induced?
Your LMC (Doctor or Midwife) has prescribed CERVIDIL to induce your labour. This is a slow release Prostaglandin. It contains a hormone similar to those produced naturally by your body which helps to stimulate labour. It helps prepare your cervix for labour (this is known as “cervical ripening”).This information sheet gives you answers to some common questions about cervical ripening and CERVIDIL from a patient’s perspective. Please ask your LMC if you require more detailed information What happens during Induction?
Your LMC will arrange for you to be admitted to the hospital as an in-patient. Induction is a 3 stage process and the time it takes varies with each woman and their response.
- Prior to starting the Induction the process will be explained to you and your baby's heart rate will be checked with a CTG monitor. A vaginal examination will then be carried out to check your cervix and to insert CERVIDIL.
- Once the cervix has softened and shortened the next stage is rupturing the membranes. The membranes may break by themselves but will often be broken as part of the Induction process. This will help labour to become established. You will then be transferred to the labour & birthing suite.
- Cervidil may be removed and after waiting for 30 minutes an IV (Intravenous) drip containing a hormone called Syntocinon may be given. It is used to stimulate contractions. You and your baby will continue to be monitored closely.
The pessary (vaginal insert) can be removed quickly and easily by gentle traction on the retrieval tape. After removal ensure that the entire product, pessary (vaginal insert) and retrieval system, has been removed from the vagina. It is necessary to remove the pessary (vaginal insert) to terminate drug administration when cervical ripening is judged to be complete or for any of the reasons listed below.
1. Onset of labour. For the purposes of induction of labour with CERVIDIL, the onset of labour is defined as the presence of regular painful uterine contractions occurring every 3 minutes irrespective of any cervical change.
There are two important points to note:
i) Once regular, painful contractions have been established with CERVIDIL, they will not reduce in frequency or intensity as long as CERVIDIL remains in situ because PGE2 is still being administered, nor will they reduce if CERVIDIL® is removed because the woman is in labour; or
ii) Patiens, particularly multigravidae, may develop regular painful contractions without any apparent cervical change. Effacement and dilatation of the cervix may not occur until uterine activity is established. Because of this, once regular painful uterine activity is established with CERVIDIL in situ, the pessary (vaginal insert) should be removed irrespective of cervical state to avoid the risk of uterine hyperstimulation.
2. Spontaneous rupture of the membranes or amniotomy.
3. Any suggestion of uterine hyperstimulation or hypertonic uterine contractions.
4. Evidence of foetal distress.
5. Evidence of maternal systemic adverse PGE2 effects such as nausea, vomiting, hypotension or tachycardia.
6. At least 30 minutes prior to starting an intravenous infusion of oxytocin.
7. If there has been insufficient cervical ripening in 24 hours.
On removal of the product from the vagina, the pessary (vaginal insert) will have swollen to 2-3 times its original size and be pliable.
There are several pain relief options which should be discussed with your LMC during your pregnancy and prior to starting the induction so that you know what is available.
What are the risks of induction?
A small percentage of women are sensitive to Prostaglandin. This can result in over-stimulation of the uterus causing too frequent or prolonged contractions which can affect the babys’ heart rate. If this happens CERVIDIL will be removed immediately by gently pulling on the retrieval cord. You may also be given a drug to relax the uterus and stop it contracting. This is extremely rare and usually resolves within 2-13 minutes upon removal of CERVIDIL. Your Doctor will review the best way to continue with your Induction.
There is also a possibility of the Induction not being successful; your Doctor will need to review the future plan for you and your baby. This may mean a Caesarean Section is necessary.
What is cervical ripening?
“Cervical ripening” changes the cervix (the neck of the womb, at the top of the birth canal) so that the baby can pass out of the womb into the birth canal. Cervical ripening is a natural step during normal labour. The cervix softens and opens. Around the time of delivery the body produces a substance called prostaglandin, which helps this happen.
Why might I need CERVIDIL?
Sometimes the cervix doesn’t soften and widen enough naturally, or labour needs to be induced. Then prostaglandin can be given, for example CERVIDIL.
What is CERVIDIL?
CERVIDIL looks like a long white tape with a thickening at one end. The thickened part contains prostaglandin. It is placed high up in the birth canal (vagina), close to the cervix. Once CERVIDIL is positioned; it very gradually releases prostaglandin, over a maximum recommended period of 24 hours. The tape to withdraw CERVIDIL hangs from the opening to the vagina.
What can I expect after CERVIDIL is inserted?
Once CERVIDIL is in place, you should remain lying down for at least 30 minutes afterwards. Your doctor or midwife will advise you when you can get up again. After that, you can walk around if you like. While CERVIDIL is in place, you will be checked frequently. Checks include your cervix, the strength and frequency of your contractions and the health of your baby. Tell your doctor or midwife about any changes or worries. For example, if you experience a sudden flow of liquid from the vagina this probably means your waters have broken. Also tell your doctor or midwife about any bleeding from the vagina or any increase in painful contractions.
Is it ok to go to the toilet, bathe or shower after CERVIDIL is inserted?
Yes. Be careful not to pull on the removal string. After urinating or bathing, pat yourself dry instead of wiping so as not to dislodge the CERVIDIL insert. If the insert accidentally comes out, do not put it back in. Tell your doctor or midwife immediately.
CERVIDIL - Dinoprostone (Prostaglandin E2) Pessary 10mg (0.3mg/hr release rate)
CERVIDIL is a hospital only prescription medicine.
As with all medicines CERVIDIL has risks and benefits. Speak to your doctor or midwife to see if CERVIDIL is right for you.
Note: Information on this site is not intended to replace the advice given by your doctor or other health professional.
For further information, click on the helpful links below.
TAPS no: PP3212. Website last updated January 2009.
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Last Updated: 30-07-2010