Dinoprostone cervical enhances blood circulation, accelerating its maturation (softening, smoothing and disclosure), which corresponds to the characteristic of the normal changes occurring birth. Cervical Ripening reduces cervical resistance while increasing the contractile activity of the myometrium and delivery. The specific mechanism of action of PGE2 at intracervical still not fully understood. Dinoprostone is also able to provide a stimulating effect on the smooth muscles of the gastrointestinal proviron dosage tract, which can sometimes cause nausea and / or vomiting in the appointment for cervical ripening product.
In large doses, dinoprostone can cause decreased blood pressure (probably due to its action on the smooth muscles of blood vessels) and increased body temperature; however, these effects are not observed when using dinoprostone in doses recommended for cervical ripening.
After administration of 0.5 mg intracervical maximum concentration is achieved after 30 dinoprostone plasma – 45 minutes, and then rapidly reduced to normal, regardless of the level of uterine activity. Dinoprostone binding to albumin in blood plasma is 73%.
Distribution and metabolism is
dinoprostone is well distributed in the body of the mother.
PGE2 is rapidly metabolized to form 13, 14-dihydro-15-keto-PGE2, which is then transformed into 13,14-dihydro-15-keto-PGA2. Dinoprostone completely metabolized in the body: in largely in the lungs and then the liver and kidneys. The blood and urine are detected at least 9 PGE2 metabolites.
dinoprostone and its metabolites are excreted in the kidneys, small amounts – through the intestines.
Stimulation of cervical ripening in the presence of medical and obstetric indications for induction of labor at term and is close to full-term pregnancy.
- Hypersensitivity to prostaglandins or any proviron dosage other component of the formulation; multiple pregnancy;
- 6 or more full-term pregnancies in history;
- tetanus or hypertonicity of the uterus;
- placenta previa or vessels;
- if there was no insertion of the fetal head;
- surgery on the uterus in history (eg, cesarean section or hysterectomy);
- difficult and / or traumatic birth (in history);
- prior to fetal distress;
- clinical or anatomical narrow pelvis;
- Any presentation of the fetus, except for the occipital;
- arrhythmias fetal heart rate;
- obstetric situation in which the preferred surgical procedure;
- discharge from the genital tract (including spotting) of unknown etiology;
- cervicitis and vulvovaginitis;
- heart, lung, kidney or liver disease in the acute stage of the mother; autopsy of membranes (dripping water) of any origin.
Precautions: cardiovascular disease, hypertension, disorders of the liver and / or kidney disease, asthma, increased intraocular pressure, epilepsy, age, women over 35 years old, pregnant for more than 40 weeks.
Pregnancy and lactation
Any dose that causes sustained increases tone of the uterus, is a risk to the embryo or fetus. In preclinical studies, it was found that prostaglandin E2 has an embryotoxic and causes an increase in the incidence of skeletal abnormalities. During feeding the drug is not used breast.
DOSAGE AND ADMINISTRATION
The initial dose: all the contents of the syringe (0.5 mg dinoprostone in 3 g gel) using the supplied catheter is introduced into the cervical canal just below the level of the internal os. After injection the patient must lie for 10-15 minutes on the back, to minimize leakage of the gel.
If the response to the initial dose is not reached, the drug is administered repeatedly. The recommended dose is re – 0.5 mg, and the interval from the previous administration – at least 6 hours.
additional appointments necessary to determine the clinical situation. The maximum recommended dose per 24-hour period is 1.5 mg.
Instructions for the syringe assembly
Remove the sterile syringe and catheter from the package.
- Remove the syringe tip cap.
- Insert the syringe cap in order to proviron dosage use it as a piston.
- Firmly attach the catheter to the tip of the syringe (click), and enter the contents of the syringe to the patient.
tetanic uterine contraction (increase in the frequency or duration of the contractions, hypertonicity of the uterus), rupture of the uterus, premature opening of membranes, nausea, vomiting, diarrhea, fever, back pain, feeling of heat in the vagina, hypersensitivity reactions, local irritation of tissues / erythema, rash, transient vasovagal symptoms (hot flashes, trembling, headache, dizziness), placental abruption, amniotic fluid embolism, rashes, asthma, bronchospasm, chest tightness.
Violations of the circulatory system and the lymphatic system: an increased risk of postpartum disseminated intravascular coagulation in pregnant women, the use of dinoprostone stimulated; leukocytosis.
Effect on the fetus: fetal distress syndrome (changes in fetal heart rate), reduced assessment of the newborn state Apgar scores below 7, compression of the fetus, fetal acidosis, antenatal / intrapartum fetal death.
Overdose Symptoms: hypertonicity of the uterus, strengthening and acceleration of uterine contractions, fetal distress, reduced assessment of the newborn state Apgar scores below 7, compression of the fetus, fetal acidosis, antenatal / intrapartum fetal death.