Consensus Statements for the use of Dinoprostone vaginal insert in the induction of labor

• When natural processes can't provoke labor in women at term, Dinoprostone facilitates natural delivery by facilitating cervical ripening and uterine contractions. 
• Administer Dinoprostone Vaginal Insert in an in-patient setting under meticulous supervision, mandating non-discharge post-insertion.
• Store Dinoprostone Vaginal Insert within a freezer (not refrigerator), maintaining temperatures between - 10◦C and -25◦C.
• It is contraindicated to use Dinoprostone Vaginal Insert with oxytocin concurrently. Defer oxytocin initiation until 30 minutes post removal of Dinoprostone to permit simultaneous use with mechanical methods like Foley's or Balloon Catheter.
• The best practice is to timely remove Dinoprostone Vaginal Insert upon the establishment of painful uterine contractions.
• To increase the efficacy of Dinoprostone Vaginal Insert, cleanse with 20 mL 0.9% saline wash before insertion to elevate vaginal pH and enhance Dinoprostone release.
• Quick insertion of Dinoprostone Vaginal Insert within 30 seconds post-freezer removal highlights the importance of patient positioning before removal. Optimal placement in the posterior vaginal fornix transversely is the recommended technique.
• When opening the package via perforation, push the tape from the bottom promptly during pack tearing to hasten the process and save time.
• To enhance awareness, an educational initiative targeting postgraduate students is recommended. This initiative should focus particularly on cold chain maintenance and administration protocols to ensure a lifelong improvement in expertise.
• The typical duration for labor induction with Dinoprostone Vaginal Insert ranges from 14-16 hours. However, it can sometimes be 10 to 20-22 hours.
• Post-insertion of Dinoprostone, the waiting period can be up to 24 hours for the initiation of labor.
• The Indian obstetric scenario is not yet ready for outpatient deployment of DVI for IOL due to limited awareness.