Pharmacological properties
Prostin E2 is a prostaglandin E2 preparation that stimulates contractile activity and tone of the myometrium.
When administered endocervically, Prostin E 2 promotes preinduction softening (ripening) of the cervix in patients with unfavorable induction parameters. The specific mechanism of action is not fully understood. In clinical studies, it was found that dinoprostone increases the blood supply to the cervix, similar to what happens in the initial period of spontaneous labor. These data suggest that endocervical administration of dinoprostone affects hemodynamics in the cervix, which contributes to its maturation.
After endocervical administration at a dose of 0.5 mg, the concentration of dinoprostone in blood plasma reaches a maximum level after 30-45 minutes, after which it quickly decreases to the initial level regardless of the level of uterine activity.
Indication
The vaginal gel is used to induce labor in women with full-term or near-term pregnancies.
Application
For induction of labor, vaginal gel is used in an initial dose of 1 mg. The gel is injected into the posterior vaginal fornix. If necessary, a second dose of gel can be administered after 6 hours, which is from 1 to 2 mg. Gel in a dose of 2 mg is prescribed in case of complete lack of effect from the first administration. In a dose of 1 mg - to enhance the effect already achieved.
Contraindication
Hypersensitivity to the drug, non-cephalic presentation of the fetus; multiple pregnancy, 6 or more pregnancies, cesarean section or other surgical interventions on the uterus in history; discrepancy between the size of the fetal head and the size of the mother's pelvis; change in fetal heart rate, indicating the onset of adverse changes in its condition; in an obstetric situation in which the benefit / risk ratio for the mother and fetus indicates in favor of surgical intervention; in the presence of pathological (including bloody) vaginal discharge of unknown etiology during pregnancy; non-parietal presentation of the fetus.
Side effects
In the mother - abnormal uterine contractions (increased myometrial tone, frequency or duration of contractions), uterine rupture, nausea, vomiting, diarrhea, fever, back pain, feeling of warmth in the vagina, hypersensitivity reactions; in the fetus - distress syndrome, change in heart rate, fetal death.
Special instructions
Prostin E2 is prescribed with caution to patients with cardiovascular diseases, impaired liver or kidney function, glaucoma, increased intraocular pressure, rupture of the chorioamniotic membrane.
Care should be taken when administering the drug to avoid injecting it above the level of the internal pharynx. Administration of the gel into the extraamniotic space has been shown to cause uterine hyperstimulation.
Patients with severe kidney or liver disease accompanied by metabolic disorders, as well as patients with cardiovascular disease, require particularly careful monitoring.
During the period of use of the drug in order to detect possible signs of side effects, such as uterine hypertonicity, prolonged uterine contractions or fetal distress syndrome, it is necessary to closely monitor the condition of the fetus (control of heart rate), uterine activity and the condition of its cervix (dilation, softening and smoothing). If the patient develops signs of uterine hypertonicity, prolonged excessive uterine contractions, or fetal tachycardia is noted, another delivery tactic should be chosen.
With prolonged high-tonic uterine contractions, the possibility of uterine rupture should be considered. If there is a history of hypertensive or tetanic uterine contractions, it is recommended to carry out continuous monitoring of uterine activity and fetal condition. Before prescribing Prostin E 2, it is necessary to assess the ratio of the size of the pelvis and the fetus.
Interactions
Prostaglandins potentiate the effect of oxytocin on the uterus. These drugs should not be used simultaneously (there is a risk of uterine rupture), and with sequential administration, the patient's condition requires strict monitoring. It is recommended to use oxytocin sequentially after the introduction of dinoprost vaginal gel with an interval of at least 6 hours.
Overdose
Leads to a significant increase and frequency of uterine contractions. Symptoms of an overdose of Prostin E2 when using it in the form of a gel are possible only with increased sensitivity to the drug. In this case, the drug must be removed from the vagina, the patient must be placed in a semi-recumbent position on her side. Oxygen therapy is indicated.
If drug withdrawal is not sufficient to stop uterine hyperactivity and/or prevent fetal distress syndrome, intravenous administration of β-adrenergic agonists is indicated. If this therapy is ineffective, prompt delivery is indicated.
Storage conditions
In the refrigerator at a temperature of 2-8 °C.
