Misoprostol
What is misoprostol?
Prostaglandin E1
What is dinoprostone?
What are the two broad types of balloon catheters that ACOG discusses for cervical ripening?
Single-balloon and double-balloon catheters
What two types of cervical-ripening methods are combined when using combination therapy?
A pharmacologic method + a mechanical method.
How many micrograms are in the standard misoprostol tablet from which smaller cervical-ripening doses can be divided?
100 mcg
Which route of misoprostol has demonstrated greater efficacy for achieving vaginal delivery within 24 hours: oral or vaginal?
Vaginal misoprostol
Vaginal administration resulted in more vaginal births within 24 hours and a shorter induction-to-vaginal-delivery interval.
What are the two commercially available vaginal formulations of dinoprostone in the United States?
Vaginal gel (Prepidil) and vaginal insert (Cervidil)
Where is the balloon of a single-balloon catheter positioned?
Through the cervix with the balloon positioned above the internal os.
What is ACOG’s recommendation regarding combining pharmacologic and mechanical cervical ripening?
ACOG suggests combination therapy in appropriate candidates to shorten the time from admission to delivery.
What is the maximum cumulative dose of dinoprostone vaginal gel recommended by the manufacturer in 24 hours?
1.5 mg
(Three 0.5-mg doses)
What is the recommended vaginal dose and dosing interval of misoprostol for cervical ripening?
25 mcg vaginally every 3–6 hours.
What is the standard dose and maximum number of doses for dinoprostone vaginal gel?
0.5 mg every 6 hours, maximum 3 doses in 24 hours.
Does ACOG recommend one balloon catheter over the other?
No! The double-balloon catheter is more expensive and has not been shown to be more effective for vaginal delivery rate or time to delivery than the single balloon catheter.
What was the specific combination identified by the network meta-analysis as having the most favorable overall efficacy/safety profile?
30-mL Foley balloon + 25 mcg vaginal misoprostol
A patient receives vaginal misoprostol 25 mcg at 0800. What is the shortest interval at which another vaginal 25-mcg dose could be administered according to ACOG’s summarized regimen?
1100 — 3 hours later
Name the two oral misoprostol dosing strategies ACOG recognizes for cervical ripening.
What pharmacologic characteristic of the dinoprostone vaginal insert makes it advantageous over misoprostol in the setting of tachysystole or a concerning fetal heart rate pattern?
It is a retrievable vaginal insert, allowing rapid discontinuation of drug exposure by removing the insert.
Digital versus speculum placement of a balloon catheter: which approach was associated with improved patient satisfaction?
Digital placement.
Importantly, this improvement occurred without worsening clinical outcomes.
ACOG reports that studies of Foley balloon cervical ripening have evaluated inflation volumes ranging from what minimum to what maximum volume?
30-80mL
A patient receives oral misoprostol 25 mcg. What is the shortest interval between doses under the low-dose oral regimen?
2 hours
Compared with vaginal dinoprostone, vaginal misoprostol was associated with what two important efficacy differences?
What is the dose and maximum duration of the dinoprostone vaginal insert?
10 mg, which can remain in place for up to 12 hours.
What is the major safety advantage of mechanical cervical ripening compared with pharmacologic methods?
A more favorable safety profile with respect to uterine hyperstimulation/tachysystole with fetal heart rate changes.
Compared with Foley balloon alone, what fetal heart rate-related adverse outcome was not increased when Foley balloon was combined with vaginal misoprostol?
Tachysystole
Match each regimen:
with:
A. 10 mg up to 12 h
B. 25 mcg q3–6 h
C. 0.5 mg q6 h, max 3 doses
D. 25 mcg q2 h
E. 50–100 mcg q4 h
1-B, 2-D, 3-E, 4-C, 5-A