Why use a drug like Prepidil (gel)? Reviews about the effectiveness of the medication, as well as the indications of this remedy will be described a bit below. We will also provide information on how to use the mentioned drug, how much it costs and what is its principle of action.
Description, packaging and composition
In what packaging is the medicine “Prepidil” available? Intracervical gel goes on sale in disposable polyethylene syringes complete with a catheter. They are placed in blisters and cardboard boxes, respectively.
The translucent and viscous preparation "Prepidil" (gel) contains such an active ingredient as dinoprostone. As auxiliary substances, colloidal anhydrous silicon dioxide and triacetylglycerol are added to it.
Mechanism of action
What is the medicine "Prepidil"? The gel during childbirth stimulates the maturation of the cervix. Its active substance is an unsaturated fatty acid that is synthesized under physiological conditions.
The specific principle of the drug during its intracervical use has not been studied. However, experts believe that dinoprostone is able to increase blood supply to the cervix, thereby accelerating its maturation (softening, smoothing and revealing). Such actions fully correspond to the normal occurring birth changes, which lead to a decrease in cervical resistance and an increase in myometrial contraction, as well as to delivery.
It should be noted that the active element of the drug in question can also have a stimulating effect on the muscles of the digestive tract. In rare cases, this causes nausea or vomiting in the woman in childbirth.
In high doses, dinoprostone is able to lower blood pressure (due to the effect on the smooth muscles of blood vessels and capillaries), as well as increase body temperature. However, it should be noted that all these effects are not observed when the drug is taken correctly, that is, in recommended doses for cervical ripening.
Kinetics
What kinetic indicators are inherent in the medicine "Prepidil"? The gel, the price of which is indicated below, after intracervical administration in an amount of 500 μg reaches its maximum concentration in the blood after 35-45 minutes. After that, the content of the active substance quickly decreases to the initial level (regardless of the contractile activity of the uterus).
Dinoprostone binds to human albumin by 73%. In this case, the active component of the drug is distributed over all tissues and biological fluids of the woman's body.
To a large extent, dinoprostone is metabolized in the lungs, as well as in the kidneys and liver. At least nine metabolites of prostaglandin E 2 are found in human urine and blood.
Most of the active substance “Prepidil” is excreted through the kidneys, and in small quantities together with feces.
Indications
Why is the medicine “Prepidil” necessary? The gel helps to stimulate cervical ripening. It is used only if there is evidence for labor.
Contraindications
Gel for stimulation of labor is not used in conditions for which prolonged contractions of the uterus are contraindicated. These include:
- multiple pregnancy;
- lack of insertion of the fetal head;
- from 6 full-term pregnancies;
- traumatic or difficult birth (including a history);
- surgical interventions on the uterus or cesarean section (including a history);
- a mismatch in the size of the pelvis of the mother and the fetal head;
- fetal distress (previous);
- a situation in which surgery is preferable;
- irregularities in the rhythm of the heart contractions of the fetus;
- bleeding from the genital tract during pregnancy (of unknown origin);
- genital tract infections (lower sections);
- abnormal presentation of the fetus ;
- hypersensitivity to gel ingredients.
With caution, the drug in question is used for arterial hypertension, cardiovascular diseases, impaired liver function, bronchial asthma, impaired renal function, an opened fetal bladder, ophthalmic hypertension or glaucoma.
The drug "Prepidil" (gel): instructions
As the initial dosage, the entire contents of the syringe are used, using the attached catheter for this. It is introduced into the cervical canal, which is located below the level of the internal pharynx.
As soon as the gel is introduced, the woman in labor should lie on her back for ¼ hours. This is necessary in order to minimize leakage of the drug.
If stimulation to the initial dose of the drug has not occurred, then the medication is administered again (after 6 hours). The dose for repeated administration of the drug remains the same.
The need for additional use of the gel is determined based on the clinical situation.
The maximum daily dosage of the medication in question is 1.5 mg.
Mode of application
How should I use the gel to stimulate labor? The instruction contains the following step-by-step actions:
- Remove the sterile syringe and catheter from the packaging.
- Remove the cap from the tip of the syringe.
- Insert the cap into the syringe (on the other hand) to use it as a piston.
- Place the catheter (tightly) over the tip of the syringe so that liquor occurs.
- Enter the woman in labor the entire contents of the syringe.
Adverse reactions
What side effects can the drug “Prepidil” cause? The gel in a woman in labor can provoke titanic contractions of the uterus (increase in her tone, frequency and duration of contractions), as well as nausea, uterine rupture, vomiting, back pain, diarrhea, fever, hypersensitivity reactions and a sensation of heat in the vagina.
In the fetus, this drug can cause the development of distress syndrome, as well as change the heart rate, reduce the assessment of the condition of the newborn on the Apgar scale to 7 points. Among other things, the use of the medication in question is rare, but still becomes the cause of stillbirth.
The drug "Prepidil" (gel): reviews and price
The cost of this tool is quite high. One syringe with gel can be purchased for 580-650 rubles. It should be noted that the use of this drug is required only in a hospital setting.
Doctors say that for the use of "Prepidil", you should first evaluate the compliance of the woman's pelvis and the size of the fetal head. If they do not match, then the medication is not used.
According to patients, the drug in question can cause a huge number of side effects, including life-threatening ones. Therefore, most of them refuse to use this gel, especially after reaching 35 years of age.