Prostaglandin F2 Alpha (Dinoprost, PGF2alpha)

Last updated 20.09.12

 

Definition

-  Intramyometrial prostaglandin used in PPH to assist with uterine contraction

 

Features

-  Should be used with

-  Anaesthetist cover

-  x2 large bore cannula

-  Pulse oximetry + O2

-  Typically administered in theatre due to risk of side effects & severity of PPH

 

Mechanism

- Potent smooth muscle contraction

 

Indications

- Severe PPH not responsive to Oxytocin, Ergometrine & uterine massage

 

Contraindications

- Severe asthma or lung disease (COPD..)

- Cardiovascular disease

 

Side Effects

- Cardiorespirtaory depression

- Abdominal cramps

- Diarrhoea

- Vomiting

 

Equipment

- Dinoprost (PGF2 Alpha ampule 5mg/ml)

- 10ml Syrine

- 10ml Normal Saline for injection (0.9%)

- Drawing up needle

- 21 or 22G Spinal needle

- Sterile swab

- Sterile gloves

 

Dose

- 1mg intramyometrial

- Ampules 5mg/ml

- Max dose 3mg

- Preparation

-  Dilute 5mg/ml (1 ampule) to 10ml with Normal Saline 0.9%

-  Solution = 0.5mg/ml in 10mls total

-  Discard 4ml (2mg) so that 3mg remains in 6ml (which is maximum dose)

-  10ml syrine with 6mls of 3mg PGF2 Alpha

 

Procedure

- Usually in operating theatre to manage side effects

- Patient supine

- Palpate fundus with non-dominant hand

- Insert spinal needle into uterine fundus

- Infiltrate intramyometrially

-  Attempt to disctibute dose through more than one region

-  At Laparotomy or LUSCS

-  2ml (1mg) via 21G spinal needle with aspiration to prevent systemic admin

-  Repeated in 10-25min PRN

-  Post vaginal delivery

-  1ml (0.5mg) via 22G spinal needle

 

 

 

References