Dinoprostone

INTRODUCTION

Indications

Endocervical Gel, Vaginal Insert: Used to “ripen” the cervix in pregnancy at or near term when induction of labor is indicated. Vaginal Suppository: Induction of midtrimester abortion, Management of missed abortion up to 28 wk, Management of nonmetastatic gestational trophoblastic disease (benign hydatidiform mole).

Action

Produces contractions similar to those occurring during labor at term by stimulating the myometrium (oxytocic effect). Initiates softening, effacement, and dilation of the cervix (“ripening”). Also stimulates GI smooth muscle. Therapeutic Effects: Initiation of labor. Expulsion of fetus.

Adverse Reactions/Side

Effects Endocervical Gel, Vaginal Insert

GU: uterine contractile abnormalities, warm feeling in vagina. MS: back pain. Misc: fever.

Suppository

CNS: headache, drowsiness, syncope. Resp: coughing, dyspnea, wheezing. CV: hypotension, hypertension. GI: diarrhea, nausea, vomiting. GU: UTERINE RUPTURE, urinary tract infection, uterine hyperstimulation, vaginal/uterine pain. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, chills, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Be alert for signs of uterine rupture. Signs include increased bleeding, sudden abdominal pain, and changes in fetal heart rate. Notify physician or nursing staff immediately if these signs occur.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension resulting in syncope) or a sustained increase in BP (hypertension).

Interventions

• Provide massage, other manual techniques, or relaxation techniques as needed to relieve back pain and pain associated with childbirth.

Patient/Client-Related Instruction

• Instruct patient to report other bothersome side effects such as severe or prolonged headache, chills, fever, or GI problems (diarrhea, nausea, vomiting).

Pharmacokinetics

Absorption: Rapidly absorbed.

Distribution: Unknown. Action is mostly local.

Metabolism and Excretion: Metabolized by enzymes in lung, kidneys, spleen, and liver tissue.

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: Hypersensitivity to prostaglandins or additives in the gel or suppository; The gel/insert should be avoided in ...