Dinoprostone (PGE2)

Indications & Dose:

Cervical ripening and induction of labour at term

• BY VAGINA

Adult: 1 pessary, insert pessary (in retrieval device) high into posterior fornix and remove when cervical ripening adequate; if oxytocin necessary, remove 30 minutes before oxytocin infusion; remove if cervical ripening inadequate after 24 hours (dose not to be repeated)

PROSTIN E2 VAGINAL GEL

Induction of labour

• BY VAGINA

Adult: 1 mg, inserted high into the posterior fornix (avoid administration into the cervical canal), followed by 1–2 mg after 6 hours if required; maximum 3 mg per course

Induction of labour (unfavourable primigravida)

• BY VAGINA

Adult: 2 mg, inserted high into the posterior fornix (avoid administration into the cervical canal), followed by 1–2 mg if required, after 6 hours; maximum 4 mg per course

PROSTIN E2 VAGINAL TABLETS

Induction of labour

• BY VAGINA

Adult: 3 mg, inserted high into the posterior fornix, followed by 3 mg after 6–8 hours, to be given if labour not established; maximum 6 mg per course

Contraindications:

SUPP: Acute PID; cardiac, pulmonary, renal, or hepatic disease; viable fetus;
GEL: History of major uterine surgery (including C-section with vertical uterine scar), cephalopelvic disproportion, grand multiparae (_6 previous term pregnancies), nonvertex presentation, hyperactive or hypertonic uterine patterns, fetal distress, obstetric emergencies favoring surgical intervention, placenta previa or unexplained vaginal bleeding, vasa previa, active herpes genitalia 

Side Effects:

Cautions:

Precautions:

Asthma, glaucoma, hepatic/renal dysfunction impairment, hypotension, hypertension, cardiovascular disease, anemia, jaundice, diabetes, epilepsy, chorioamnionitis, cervicitis, infected endocervical lesions, acute vaginitis, previous Csection with transverse uterine scar, ruptured membranes 

Interaction:

Drugs
Oxytoxin: Augmented activity, use sequentially not concurrently (6-12 hr after gel, 30 min after removal of insert)

Warnings:

Adverse Effects:

Lactations:

Pregnancy category C; complete any failed attempts at pregnancy termination by some other means 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Chills, dizziness, fever, headache
CV: Hypertension (transient)
GI: Diarrhea, nausea, vomiting
GU: Vaginal pain, vaginismus, vaginitis, vulvitis
HEME: Transient leukocytosis
MS: Joint swelling, leg cramps, weakness
SKIN: Rash, skin color changes 

Patient And Carer Advice: