BP

Dinoprostone

Proprietary

Prostin E2^® (Pharmacia Ltd)

Group

Prostaglandins

Uses/indications

Induction of labour – ripening of the cervix for labour when there are no fetal or maternal contraindications

Type of drug

POM

Presentation

Prostin E2 Vaginal Gel 1 mg
Prostin E2 Vaginal Gel 2 mg
Translucent, thixotropic gel (NICE 2008 does not recommend tablets, IV solution or extra-amniotic solution for induction of labour)
Where tablets are used:
Prostin E2 Vaginal Tablets 3 mg

Dosage

Route of admin

P.V. (not intracervical)

Contraindications

Hypersensitivity, if oxytocic drugs are contraindicated or where prolonged contractions of the uterus are considered inappropriate, e.g. caesarean section or majoruterine surgery, potential or obstructed labour, pelvic

inflammatory disease (unless adequate prior treatment), active cardiac, pulmonary, renal or hepatic disease
CAUTION: asthma or a history of asthma, epilepsy or a history of epilepsy, glaucoma or raised intraocular pressure, compromised cardiovascular, hepatic, or renal function, hypertension, in women with compromised (scarred) uterus and women aged 35 years or older

Side effects

Asthma, bronchospasm, cardiac arrest, hypertension, rash, diarrhoea, nausea, vomiting, fever, anaphylactoid and anaphylactic reactions including anaphylactic shock, back pain, uterine hypertonus, uterine rupture, abruptio placenta, pulmonary amniotic fluid embolism, rapid cervical dilatation, uterine hypercontractility with/without fetal bradycardia, fetal distress/altered fetal heart rate (FHR), neonatal distress, neonatal death, stillbirth, low Apgar score, warm feeling in vagina, irritation, pain, increased risk of postpartum disseminated intravascular coagulation

Interactions

Oxytocics – uterotonic effect enhanced, hence it is not recommended that these drugs are used together
If used in sequence, uterine activity MUST be monitored carefully

Pharmacodynamic properties

A prostaglandin of the E₂ series that induces myometrial contractions and promotes cervical ripening

Fetal risk

ABORTIFACIENT: exposure to fetal skin in utero causes fetal heart rate abnormalities and may predispose to neonatal jaundice

Breastfeeding

Considered moderately safe, but with extremely limited data on the consequences of administration in breastfeeding women

BP

Dinoprostone

Proprietary

Propess^® (Ferring Pharmaceuticals Ltd)

Group

Prostaglandins

Uses/indications

Induction of labour – ripening of the cervix for labour when there are no fetal or maternal contraindications

Type of drug

POM

Presentation

A thin, flat semi-opaque polymeric vaginal delivery system which is rectangular in shape with radiused corners contained within a knitted polyester retrieval system

Dosage

10 mg vaginal delivery system
If there is insufficient cervical ripening in 24 h, the vaginal delivery system should be removed
Following the removal of the vaginal delivery system at least 30 min is recommended before oxytocin is commenced
Administration
PROPESS should be removed from the freezer immediately before insertion
The vaginal delivery system should be inserted high into the posterior vaginal fornix using only minimal water-soluble lubricants
Once inserted, the withdrawal tape may be cut, ensuring there is sufficient tape outside the vagina to allow removal. The end of the tape MUST not be tucked into the vagina as this would make it difficult to remove
The patient should remain recumbent for 20–30 min after insertion

Dinoprostone will be released continuously over a period of 24 h, hence it is important to monitor uterine contractions and fetal condition
Removal
Gentle traction on the retrieval tape
Removal stops further drug administration when cervical ripening is judged to be complete, e.g. onset of labour, once regular, painful contractions have been established. In multigravidas the vaginal delivery system should be removed irrespective of cervical state to avoid the risk of uterine hyperstimulation, spontaneous rupture of the membranes or amniotomy, uterine hyperstimulation or hypertonic uterine contractions, evidence of fetal distress, maternal systemic adverse dinoprostone effects such as nausea, vomiting, hypotension or tachycardia, at least 30 min prior to starting an intravenous infusion of oxytocin

Route of admin

P.V. (not intracervical)

Contraindications

When labour has started, with other oxytocic drugs, when strong prolonged uterine contractions would be inappropriate, e.g. previous major uterine surgery (caesarean section, myomectomy), cephalopelvic disproportion, fetal malpresentation, fetal distress, more than three full-term deliveries, previous surgery or rupture of the cervix, current pelvic inflammatory disease (unless adequate prior treatment has been instituted), hypersensitivity, placenta praevia or unexplained vaginal bleeding during the current pregnancy
CAUTION: asthma or a history of asthma, epilepsy or a history of epilepsy, glaucoma or raised intraocular pressure, compromised cardiovascular, hepatic or renal function, hypertension, in women with compromised (scarred) uterus and women aged 35 years or older

Side effects

Asthma, bronchospasm, cardiac arrest, hypertension, rash, diarrhoea, nausea, vomiting, fever, anaphylactoid and anaphylactic reactions including anaphylactic shock, back pain, uterine hypertonus, uterine rupture, abruptio placenta, pulmonary amniotic fluid embolism, rapid cervical dilatation, uterine hypercontractility with/without fetal bradycardia, fetal distress/altered fetal heart rate (FHR), neonatal distress, neonatal death, stillbirths, low Apgar score, warm feeling in vagina, irritation, pain