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Can the mere administration of the prostaglandin gel (or pessaries) cause the membranes to rupture?
This occasionally happens. Following instillation of the prostaglandin gel, changes take place to the cervix. As a direct result of this, probably combined with low-grade uterine activity, rupture of membranes may occur.
Can labour commence after prostaglandins without need for the other steps in the induction process?
This frequently happens. Besides the cervix, the uterus itself may respond as well, with contractions following shortly after the prostaglandin has been instilled. This means labour is established and will be managed like any other labour.
What happens if the cervix does not respond to prostaglandins?
This is a difficult situation and the attending obstetrician has to weigh up the options. One will be to try and go ahead with amniotomy (rupturing the membranes) and an oxytocin infusion. Such a strategy has a high chance of failure, especially if the cervix is in a very unfavourable state. It simply won't open.
The second option is to postpone the procedure for a few days and try again later. This is only possible where there is no concern for the baby's well-being by the continued stay in the womb.
The third option is to abandon the failed induction and deliver by caesarean section.
What kind of side-effects can occur, following the use of prostaglandins for labour induction?
Many women complain of an aching pain that is persistent in the lower back and abdomen, following prostaglandin administration. Sometimes this is bad enough to require medication.
Hyper-stimulation of the uterus is another potential side effect. This may cause fetal distress. Using drugs called tocolytics, which allow the uterus to relax, can effectively counteract hyper-stimulation. They are given intravenously but the inhalational route has also been used with success.
Nausea, vomiting, headache, flushing and dizziness are rare and usually mild side-effects.
All these side-effects are uncommon.
Is the use of prostaglandins contraindicated anywhere?
There are a few situations where prostaglandins will not be used, including:
Where there has been significant antepartum haemorrhage (vaginal bleeding during pregnancy) or where there is confirmed placenta praevia, with or without bleeding, prostaglandins are not used
In the ocular (eye) condition known as glaucoma.
When there is an infection in the birth canal.
When the fetus is lying in an abnormal position such as breech, transversely or oblique.
What if the membranes have ruptured and the waters are draining?
Prostaglandins can still be used safely in such a situation.
What if the previous delivery was by caesarean?
This in itself is not a contraindication. However, many obstetricians are not comfortable with the idea of using prostaglandins in such circumstances. There is also fairly credible evidence that prostaglandins might have a direct weakening effect on the old scar on the womb.
Of course, if the indication for the previous caesarean section is still there, the need for inducing labour will not arise as delivery will be by a repeat caesarean section.
If prostaglandins are used to induce labour in such a situation, close observation will be maintained.