Dinoprostone

When ATH:
G02AD02

Characteristic.

The white crystalline powder. Soluble in alcohol, in alcoholic solutions, it is soluble in water.

Pharmacological action.
Uterotoniziruyuschee.

Application.

Stimulation birth at term, induction of labor at term or near term, induction to expulsion in the event of fetal death, medical abortion, attempted abortion, molar pregnancy.

Contraindications.

Hypersensitivity; the appointment for induction of labor at term a history of information on caesarean section or major surgery on the uterus, difficult and / or traumatic childbirth, pelvioperitonit, 6 or more full-term pregnancies; high degree of imbalance between the pelvis and the fetal head; prior to fetal distress, abnormal position of the fetus. When prescribing vaginal gel for induction of labor - nonmuscular presentation of the fetus, infections of the lower genital tract, bleeding from the genital tract of unspecified nature during pregnancy, revealed the fetal bladder. When prescribed for medical abortion, pelvic infection if, if not carried out an adequate prior therapy, cervicitis or infections of the vagina (contraindicated ekstraamnioticheskoe administration).

Restrictions apply.

Bronchial asthma, glaucoma, hypertension, cardiovascular diseases, epilepsy, hepatic disorders and renal function.

Side effects.

Increased uterine tone, tetanic contraction; nausea, vomiting, diarrhea, headache, dizziness, tissue irritation, erythema at the site on / in the, tides, tremor, temperature rise, leukocytosis; in the fetus - heart rhythm disturbances, asfiksija.

Cooperation.

It enhances the effect of oxytocin.

Overdose.

Symptoms: a significant increase and more frequent uterine contractions.

Treatment: in / with the introduction of beta-agonists; if ineffective, prompt delivery.

In overdose gel: the drug should be removed from the vagina, placing the patient in a reclining position on her side; shows the use of oxygen.

Dosing and Administration.

For induction of labor at term dose selected according to the sensitivity of the patient and maintained at the lowest possible level, providing sufficient reaction of the uterus and cervix normal progressive.

Inside in the first dose 0,5 mg, subsequently - 0,5 mg every hour. If uterine activity is not sufficient, increase the dose to 1 mg / h, while the activity of the uterus does not increase. It is not recommended to increase the dose over 1,5 mg / h. In case of progressive dilatation of the cervix, the dose may be reduced to 0,5 mg / h. For intravenous administration, an injection solution is used with a concentration 1,5 ug / ml. The initial infusion rate, which was maintained during the first 30 m, is 0,25 mcg / min. If the desired effect is achieved, then the rate of introduction increases to 0,5 mcg / min. In some cases, allow for a gradual increase in the rate of introduction to the 1 or 2 mcg / min. In case of uterine hypertonus or fetal distress infusion cease to normalize the status of the patient and the fetus, then the infusion may be resumed at a rate, component 50% from the last, and then gradually increase the speed.

For induction of labor, it is also possible to use a vaginal gel in an initial dose. 1 mg. The gel is injected into the posterior vaginal fornix. Through the if necessary 6 h you can enter a second dose of gel - 1-2 mg (2 mg is prescribed in case of complete lack of effect from the first injection, 1 mg is used to enhance the already achieved effect).

For the induction of the expulsion of the fetus in the event of its intrauterine death - intravenous infusion at an initial rate 0,5 mcg / min, with a further increase in speed at intervals of at least 1 no. Do not exceed the infusion rate 4 mcg / min.

For medical abortion, in case of missed abortion and with cystic drift - intravenous infusion of a solution with a concentration 5 ug / ml. The recommended initial rate of introduction for the first 30 min - 2,5 mcg / min; If the desired effect is achieved can not be, the rate of introduction is increased to 5 mcg / min. When, when after 4 h of such an infusion, the required level of uterine contractility is not achieved, then the rate of infusion is increased to 10 mcg / min. If you experience side effects reduced by 50% the infusion rate or stop it.

Precautions.

Not recommended long (more 2 days) application.

Cautions.

Use solutions with a concentration 1,5 ug / ml, 5 ug / ml. Solutions for the I / O application can be stored no more than a day. Before applying for the induction of labor should be carefully evaluated compliance with the size of the pelvis and the fetal head; during childbirth should be carefully observed for uterine activity, Over the process of maturation and cervical dilatation, fetus. With a history or hypertonic uterine tetanic contractions of the uterus and control the activity status of the fetus during the period of labor induction. If the patient has retained vysokotonichnye reduction, should consider the possibility of uterine rupture.