Summary of Recommendations
Prostaglandin E (PGE) analogs are effective in promoting cervical ripening and inducing labor.
Women in whom induction of labor is indicated may be appropriately managed with either a low- or high-dose oxytocin regimen.
Fetal heart rate and uterine activity should be continuously monitored from the time a PGE2 vaginal insert is placed until at least 15 minutes after it is removed.
High-dose PGE2 vaginal suppositories may be used in the management of intrauterine fetal demise in the second trimester of pregnancy.
Although the optimal dosage and timing interval of misoprostol are unknown, lower dosages (25 μg every three to six hours) are effective for cervical ripening and induction of labor.
With term premature rupture of membranes, labor may be induced with prostaglandins.
Use of misoprostol in women with previous cesarean delivery should be avoided because of the possibility of uterine rupture.
The use of higher dosages of misoprostol (50 μg every six hours) to induce labor may be appropriate in some situations, although increased risk of complications, including uterine hyperstimulation, has been reported.
For women with third-trimester intrauterine fetal demise, intravaginal misoprostol can be used to induce labor.
Fetal heart rate and uterine activity should be continuously monitored from 30 minutes to two hours after administration of PGE2 gel.