The manufacturer also recommends waiting 30 minutes after removal of insert before starting oxytocin.The vaginal gel (brand name Prostin E2, Canada) is administered through a prefilled syringe and the medication is placed in the posterior fornix of the vagina. After administration people should stay laying down for at least 30 minutes after they have received the drug. Contraindications
Contraindications to a medication are any reasons to not use the drug. Prostaglandin E2 (PGE2) is used to induce labor and should not be used in people that are contraindicated to give birth vaginally or spontaneous labor. PGE2 should not be used in people with allergies to prostaglandins or any components in the drugs formulations. PGE2 should be stopped before other oxytocic agents like oxytocin are given.Dinoprostone as a vaginal suppository is contraindicated for women with acute pelvic inflammatory disease or active disease of the cardiovascular, respiratory, hepatic, or renal systems. Caution is required for people with a history of cervical malignancy, hypo- or hypertension, anemia, epilepsy, jaundice, asthma, or pulmonary diseases. The suppository formulation is also not indicated for viable fetus evacuation.Endocervical gel is contraindicated in those with who have a history of C-sections or major uterine surgery, if the fetus is in distress and delivery is not imminent, vaginal bleeding throughout the pregnancy that is unexplained, history of difficult labors and deliveries, have cephalopelvic disproportion, less than six previous term babies with nonvertex presentation, hyper or hypotonic uterine patterns.
Physiological effects
Dinoprostone has important effects in labor by inducing softening of the cervix and causing uterine contraction, and also stimulates osteoblasts to release factors that stimulate bone resorption by osteoclasts.Natural prostaglandins, including PGE1 and PGE2, are important in the structure and function of the ductus arteriosus in fetuses and newborns. They allow the ductus arteriosus to remain open, providing the necessary connection between the pulmonary artery and descending aorta that allows the blood to bypass the fetuss underdeveloped lungs and be transported to the placenta for oxygenation. The ductus arteriosus normally begins to close upon birth due to an increase of PGE2 metabolism, but in newborns with congenital heart disease, prostaglandins can be used to keep the ductus arteriosus open longer than normal to sustain healthy oxygen saturation levels in the blood. Although PGE1 is more commonly used in this setting, there has been a report of oral PGE2 being used to treat ductus-dependent congenital heart diseases in newborns to delay surgical treatment until the pulmonary arteries grew. In addition, PGE2 was used in another report to dilate the ductus arteriosus in newborns with various cardiovascular defects to allow for better perfusion of the lungs and kidneys.