What week is Ginipral canceled during pregnancy. Ginipral instructions for use, contraindications, side effects, reviews. Description of the dosage form

As soon as a woman finds out that she will soon become a mother, she begins to take a close look at her body and everything that happens to it.

Therefore, pregnant women often turn to doctors with various complaints, especially with pulling pains in the lower abdomen.

Until recently, all pregnant women who treated with a similar symptom were given a terrible diagnosis of “threatened abortion”, and they often like to add uterine tone here.

I already wrote about the tone of the uterus in a separate article, be sure to read it (follow the link Tone of the uterus during pregnancy >>>).

Certainly no treatment. future mom did not stay.

And one of the frequently prescribed drugs was Ginipral. When studying the instructions for this medicine, a huge number of contraindications and side effects are striking.

Is Ginipral really necessary during pregnancy or is it prescribed just for reinsurance?

What is Ginipral

According to the instructions, Ginipral during pregnancy is a tocolytic agent that promotes rapid relaxation of smooth muscles, including the uterine muscles.

Thus, gynecologists are trying to eliminate the increased tone of the organ, thereby preventing spontaneous abortion or childbirth. ahead of schedule.

Why is it prescribed for pregnant women

Why is Ginipral prescribed during pregnancy?

This is usually done in the period from 22 to 36 weeks, if the woman has no direct contraindications to its use;
It is not advisable to take it earlier, since the receptors on which it is able to act are formed no earlier than 20 weeks (read the article on the topic: 20 weeks of pregnancy >>>);
Ginipral tablets during pregnancy are used to eliminate the threat early birth and is usually prescribed after injections of this drug. The exception is moderate hypertonicity.

Injections are prescribed for:

short-term treatment of uncomplicated hypertension;
turning the fetus in case of transverse presentation;
the need for emergency transportation of a pregnant woman.

Indications for use

Usually, doctors prescribe the use of Ginipral during pregnancy in the following cases:

increased uterine tone;
placental insufficiency;
in case of threat of early childbirth;
with detected hypoxia in the fetus (more about fetal hypoxia during pregnancy >>>).

In the form of a dropper, the drug is prescribed to stop labor activity if it started much earlier.

Thus, doctors are trying to buy a little time, for example, in order to take a woman in labor to a medical facility, where she and the newborn can be provided with qualified assistance.

Such an appointment of Ginipral at the 33rd week of pregnancy is quite common.

Important! Instructions for the use of Ginipral during pregnancy indicate that the drug is not effective until 16-22 weeks. And some experts are sure that it should be recommended for use no earlier than the 28-week period.

But what should alert even more is the fact that now this drug is prescribed along with vitamin C, as an ordinary remedy.

As soon as you complain about pulling sensations in the lower abdomen or small tonic phenomena, the doctor will immediately prescribe Ginipral. Although this drug is not used in many countries due to severe side effects.

Side effect

Ginipral, prescribed during pregnancy, has side effects. During its use, you may experience:

lack of calcium in the body;
violation of fat metabolism;
in patients with diabetes possible hyperkalemia;
bronchospasm and even pulmonary edema;
skin reactions (redness, rash, itching);
disruption of the heart;
violations of the central nervous system (dizziness, etc.);
disorders of the digestive system (nausea, vomiting, impaired peristalsis);
decrease in diuresis, which can lead to tissue swelling (read the article Edema during pregnancy >>>).

Contraindications

The drug should not be taken in such cases:

the woman suffered any disease in the first half of pregnancy;
a pregnant woman is diagnosed with ischemia;
the cervix has dilated more than 4 cm;
there was damage to the amniotic membrane;
maternal glaucoma;
with exacerbation of asthma;
in case of pathology of the liver or kidneys;
with hyperthyroidism;
with any deviations in the work of the cardiovascular system;
in the anamnesis of the pregnant woman there were any abnormalities or pathologies that led to the death of the fetus;
a woman or fetus has a pathology that threatens their life.

Ginipral with uterine tone during pregnancy should not be used, since ongoing studies have shown (here I will quote E.P. Berezovskaya, respected by me, an obstetrician-gynecologist with many years of experience and a sober look at modern obstetrics):

"beta-sympathomimetics do not decrease the frequency premature birth, do not improve pregnancy outcome, do not reduce neonatal morbidity, do not improve neonatal weight, and therefore should not be used by pregnant women, especially for the prevention of preterm birth.

Many of these drugs have never been tested on pregnant women, although they are prescribed to prolong pregnancy, and the studies that have already been carried out are not enough to talk about the safety of beta-sympathomimetics for pregnant women and their offspring.

Harm to the fetus

Attention! Despite the fact that pregnant women are often prescribed Ginipral at the 35th week of pregnancy or at another time, some gynecologists are sure that, along with a decrease in uterine tone, the drug reduces the permeability of small vessels.

As a result, the fetus may receive less oxygen and nutrients. Therefore, it can be unsafe to use it without explicit indications.

Do I need Ginipral?

Usually, expectant mothers, fearing for the baby, rush to the antenatal clinic as soon as they note any unusual condition.

Gynecologists also try to play it safe and can prescribe various medications to a pregnant woman with or without cause. Indeed, in this case, in the event of an “emergency situation”, no one will blame them for inaction.

However, that any medicinal product has its own side effects that can cause even more harm, they are modestly silent.

Important! In addition, recently there is more and more information about the far-fetchedness by doctors of such a diagnosis as “uterine hypertonicity” and the threat of premature birth, especially after 35 weeks of pregnancy.

Of course, there may be situations when, after this period, the child has not had time to gain sufficient weight and is not yet ready to be born.

Remember! But these are still isolated cases, and in the vast majority of situations, taking this and other drugs is unjustified.

What to do for those to whom the doctor has prescribed Ginipral to prevent the premature birth of a baby?

First of all, you need to calm down and soberly assess whether there are real reasons for taking this drug.

After all, as you have already noticed, the list of side effects from it is very large and dangerous.

How did you resolve the issue with Ginipral and on the basis of what was it prescribed to you? Share in the comments.

Ginipral during pregnancy is used intravenously or in tablets. Intravenously, the drug can be administered in a stream or drip.

Jet injection of Ginipral is carried out in such situations:

Uncomplicated preterm labor. Births that take place at 38 weeks or later are considered normal. If they start at 37 weeks or earlier, they are considered premature. This is an adverse event for the fetus, threatening his health. Because the body fully matures and prepares for a meeting with the outside world precisely by the 38th week. Therefore, the pregnancy is prolonged. Do it with Ginipral.

The drug can be used starting at 22 weeks and ending at 37 weeks of gestation. Before its introduction, the condition of the pregnant woman is necessarily assessed. Because the introduction of Ginipral intravenously has several contraindications. In their presence, tocolytic therapy is not carried out.

In childbirth that began at a normal time, but needs to be delayed. This need may arise for various reasons. For example, a woman is in an ambulance on her way to a maternity hospital. So that the birth does not take place immediately, and the patient has time to be taken to the destination, she is given an injection of Ginipral intravenously. Also, tocolytic therapy is used in the case of the transverse position of the fetus. The doctor can rotate it, which will facilitate and make physiological childbirth possible. But for this it is necessary that the uterus stops contracting. This effect is achieved by administering Ginipral intravenously.

In this form, the drug is used only if it is necessary to achieve quick effect. But he is short-lived. If it is necessary to achieve a long-term effect in order to prolong the pregnancy for several weeks or even months, the drug is taken in tablets. Also in a hospital, it is possible to administer Ginipral intravenously, in the form of a solution for infusion.

How Ginipral works during pregnancy

According to the mechanism of action, this drug is a selective stimulant of beta-2-adrenergic receptors. A large number of them are located in the uterus. Therefore, interaction with these receptors leads to a decrease in the muscle tone of the organ.

Ginipral suppresses contractions. This process is called tocolysis. It can suppress any uterine contractions: both natural and caused by the introduction of oxytocin hormone preparations, which is used to stimulate labor.

Due to the decrease in uterine contractility, Ginipral allows you to prolong pregnancy until the time when the birth of a child is safe. After all, the longer it develops inside the womb, the better. Today, most maternity hospitals are able to bear even severe premature babies. But in any case, it affects their health. Therefore, if it is possible to prolong the pregnancy and avoid premature birth, doctors always use it.

When administered intravenously, the drug works quickly, but for a short time. For example, if you enter Ginipral in a jet, the effect will last only 20 minutes. But it will be the maximum. In the future, long-term tocolysis is carried out, for which Ginipral droppers and tablets are used.

Advantages

Ginipral is far from the only drug that can be used to prevent preterm labor. There are other means as well. But Ginipral has a number of advantages. Thanks to them, many doctors prefer this particular drug over analogues. These advantages are as follows:

There is practically no effect on the heart muscle of a pregnant woman. Therefore, the drug is safer than other drugs from the group of beta-adrenergic receptor stimulants. This safety is achieved through high selectivity. Any substances that stimulate type 2 receptors may also act on type 1 receptors. The only question is how intensely they affect them. The more selective the drug, the less stimulated beta-1-adrenergic receptors located in the heart and blood vessels. Ginipral is one of those means that minimally affect them.
Does not negatively affect fetal-placental blood flow. The drug does not cause spasm of blood vessels. Therefore, there is no risk of hypoxic lesions of fetal tissues. With prolonged use, intrauterine growth retardation or other adverse events associated with circulatory disorders in the mother-placenta-fetus system do not develop.
Has high stability. This determines the high efficiency of the drug. Unlike some other beta-2-agonists, it contains not one, but two catecholamine groups. And the drug ceases to act only when both groups are methylated. Therefore, in the body it is more stable, less susceptible to the effects of enzymes that destroy the active substance. This is due to the high duration of the clinical effect. The drug is used less frequently than its less stable counterparts. This is more convenient for the patient.

Release forms

Ginipral is available in three forms:

pills;
injection;
concentrate for solution for infusion.

Thus, the drug can be used in pregnant women in three ways. It is prescribed in the form of intravenous injections, put in the form of a dropper and used in tablets. Often patients ask why the Ginipral dropper is needed if there are pills. They are more convenient and can be used at home. But the fact is that intravenous administration causes a faster clinical effect. If a tocolytic effect is to be obtained immediately, then such an administration would be more preferable. In the future, the woman is transferred from intravenous injections to tablets.

In solutions for injection, the drug is released in ampoules of 2 ml. This amount of solution contains 10 μg of hexoprenaline. There are 5 ampoules in the package.

In the form of a concentrate for the preparation of a solution, followed by its introduction in the form of a dropper intravenously, Ginipral is available in 5 ml ampoules. Each such ampoule contains 2 times less hexoprenaline per 1 ml. But the total number is higher. In total, 1 ampoule contains 25 micrograms of active ingredient. There are 5 ampoules in a pack.

After the introduction of Ginipral, tablets are administered intravenously. They can be used long time- up to 38 weeks of pregnancy, when it will be possible to give birth to a child at the most favorable time, after all its organs and systems are fully formed. The tool is available in tablets, each of which contains 500 micrograms of hexoprenaline sulfate.

How is the drug used intravenously?

A solution for intravenous administration is the dosage form with which treatment is started in case of premature contractions. And also in the case when delivery on time is impossible for any reason, and they need to be delayed for several hours or days.

Ginipral is never used alone. Tocolytic therapy is carried out only by a doctor or specially trained nursing staff (obstetrician). The drug is prescribed immediately after the onset of premature labor. The sooner the doctor starts treatment, the better the result.

In different clinical situations, different dosages of Ginipral are used. If childbirth begins on time, and for some reason it is necessary to delay them for a short time (for example, to turn the fetus from a transverse position or take the woman in labor to the hospital), then 10 mg of hexoprenaline is prescribed once. This is one 2 ml ampoule. It is diluted in 10 ml of saline. Enter jet, but slowly, for several minutes.

For short-term treatment of preterm labor in case of dilatation or shortening of the cervix, 10 mg (1 ampoule) of the drug is administered first. Then appoint means in the form of intravenous infusion. For this, both a solution and a concentrate can be used. It is added to an isotonic sodium chloride solution. The optimal infusion rate is 0.3 µg per minute.

The optimal amount of saline is 0.5 liters. The required amount of concentrate is added to it. Based on this, the injection rate is set. In order for the patient to receive 0.3 μg of hexoprenaline per minute, you need:

dissolve 1 ampoule of 5 ml and inject at a rate of 120 drops (6 ml per minute);
if 2 ampoules dissolve, the rate of administration is 2 times lower (60 drops or 3 ml);
when dissolved in saline 3 ampoules, the solution is administered at 40 drops per minute (2 ml);
if 4 ampoules of 5 ml are dissolved, then the rate of administration is set to 30 drops or 1.5 ml per minute.

If there is no shortening or opening of the cervix, then the dosage of Ginipral can be reduced by 2 times. That is, the drug is administered 4 times slower. That is, 1 ampoule of 5 ml is dissolved in 0.5 liters of sodium chloride 0.9%, and it is injected at a rate of 1.5 ml per minute. Or dissolve 2 ampoules, and then the rate of administration is 0.75 ml or 15 drops per minute.

Use intravenous therapy with Ginipral for no more than 2 days in a row. It makes no sense to use the remedy for longer. If the gestation period is small, then the woman is transferred to pills that she takes at home. If this is a term birth that needs to be delayed for some time, then with the help of tocolysis, labor can be delayed by only 48 hours.

How to take Ginipral tablets during pregnancy?

Tablets are taken orally with water. Treatment with the oral form of the drug begins 1 or 2 hours before the termination of infusion therapy. That is, even before hexoprenaline ceases to enter the body of a woman intravenously. This is necessary in order to ensure the continuity of the drug's effect on the muscular layer of the uterus. After all, the drug is absorbed from the intestine not instantly, but after a while. During this period of time, hexoprenaline should enter the blood intravenously.

Initially, tablets are taken every three hours, one at a time. Then the dose is reduced. One tablet is taken every 4 or 6 hours. That is, 4 to 6 times a day.

Tablets are often prescribed to a woman after discharge from the hospital, where she received intravenous infusions of Ginipral. It is very important to explain to the patient the importance of timely taking the drug in the prescribed dose. Many people find using it every few hours not very convenient. A woman may forget to take another pill. Skipping a few doses can result in an increase in the tone of the uterus and the birth of a premature baby. Therefore, the drug should be used constantly, regularly and at the dose prescribed by the doctor.

Tablets have good bioavailability. The active substance Ginipral quickly enough penetrates from the intestine into the systemic circulation. The drug is excreted mostly in the urine. After 4 hours, only one fifth of the dose remains in the blood. A small amount of hexoprenaline is eliminated in the bile.

Features of the drug

The drug affects all organs and systems. Although it is highly selective, to a certain extent it affects the contractility of smooth muscles not only of the uterus, but also of the bronchi and blood vessels. Ginipral also affects the function of the heart muscle.

Therefore, treatment is carried out only in the clinic. The following is constantly monitored:

cardiac activity (ECG);
pulse rate (it should not exceed 120 beats per minute, otherwise the drug is canceled or the dosage is reduced);
electrolyte balance (pulmonary edema is possible with the introduction of a large amount of fluid intravenously, in order to prevent this, it is better to make a more concentrated solution for infusion and inject it more slowly);
glucose and lactate in the blood - if the patient suffers from diabetes, because hexoprenaline can cause hyperglycemia;
potassium level - it can decrease under the influence of beta-2 agonists.

The introduction of the drug is stopped in case of chest pain, pathological changes on the electrocardiogram. Because it can talk about an attack of angina pectoris.

In the treatment of Ginipral there is a risk of pulmonary edema. It should be assessed before the start of the infusion. In the presence of multiple risk factors, the drug is not used. These are:

multiple pregnancy;
hypervolemia before infusion;
infectious diseases;
preeclampsia.

To reduce the risk of pulmonary edema, salt should be completely excluded from the patient's diet.

Ginipral affects cardiac activity. Its introduction increases the pulse by 20-50 beats per minute. In addition, blood pressure decreases. Diastolic may decrease by 10-20 mm Hg. Hexoprenaline has minimal effect on the cardiac activity of the fetus. He is allowed to increase his heart rate by 20 beats per minute or less.

During intravenous drip of the drug, the woman alternately is on her left side, then on her right. This avoids compression of the superior vena cava. It may be due to an excessive decrease in blood pressure.

Side effects

It should be borne in mind that Ginipral:

increases blood glucose levels;
may cause muscle weakness;
inhibits intestinal motility and can cause constipation.

Quite often, when using the drug, adverse reactions are observed. Most women develop tachycardia. With prolonged use of tablets, body fat mass may decrease. During treatment, trembling of the fingers occurs. Some people experience anxiety, headache, nausea.

In rare cases, the use of Ginipral is accompanied by complications from the cardiovascular system. Possible angina attacks. Especially if at the time of treatment the woman already has coronary heart disease. The drug increases the oxygen demand of the heart muscle. Rarely, it causes ventricular extrasystoles or atrial fibrillation.

Other side effects:

redness of the face;
sweating;
decrease in diuresis;
dizziness.

In very rare cases, expiratory dyspnea develops as a result of bronchospasm.

When is Ginipral contraindicated during pregnancy?

The drug is not used in the 1st trimester of pregnancy. It does not apply in childhood. Prohibited during lactation.

Other contraindications:

allergy;
cardiac ischemia;
up to 22 weeks;
the danger of maintaining pregnancy (intrauterine infection, ongoing bleeding, severe eclampsia, etc.);
intrauterine fetal death;
lethal malformations of its development;
bronchial asthma;
heart defects and other severe heart diseases;
thyrotoxicosis;
glaucoma;
decompensated pathologies of the kidneys and liver.

It does not make sense to prescribe the drug in cases where the opening of the cervix has reached 4 cm or more. It will most likely be ineffective.

Ginipral is an important drug that in many cases allows you to prolong pregnancy to the required time and avoid premature birth.

Increased uterine tone during gestation is a threatening condition, which is accompanied by pathological contractions of the uterine muscles. Without adequate treatment, this can result in miscarriage or early birth. Unfortunately, it is difficult to predict and even more so to prevent the development of this pathology. But if you seek medical help in time, you can avoid complications. In obstetric practice, Ginipral is used with great success. During pregnancy, many women are forced to take it in order to maintain their pregnancy or delay unplanned labor that has begun. This drug is completely allowed during pregnancy, but it has its own rules for taking and, of course, contraindications and various side effects. Therefore, let's take a closer look at the features of the use of Ginipral during pregnancy.

Features of the drug Ginipral for pregnant women: composition, therapeutic properties, dosage forms

Ginipral is a tocolytic agent that, due to the additional synthesis of norepinephrine, relaxes all smooth muscles, including the uterus. This inhibits the contractile activity of the uterus, reduces the manifestations of hypertonicity, helps the uterus to relax, which in combination prevents miscarriage or early birth.

Ginipral also suppresses pathological spontaneous contractions off schedule, which gives time to stimulate the accelerated development of the lungs in a child if a woman has a premature birth. Most often, a woman, against the background of the begun treatment, manages to convey the baby before the specified period.

The active component of the drug is hexoprynaline sulfate, which, at a stable concentration in the blood, provides a long-term therapeutic effect. At first, when hypertonicity appears, Ginipral concentrate is used to prepare liquid for infusion. After the woman's condition improves, Ginipral tablets are prescribed during pregnancy to keep the uterus relaxed.

Ginipral has high absorption properties. The tocolytic effect is manifested within 3-7 minutes after intravenous administration and lasts at least 30 minutes. The maximum effect is observed between 12 and 18 minutes after ingestion. The drug is excreted gradually over 7 days with urine and bile.

Ginipral is produced in three pharmaceutical forms with the same active substance, but different auxiliary elements.

Tablets Ginipral have a rounded shape, a white tint and are sold 10 pieces in a blister. In a tablet, in addition to 0.5 mg of hexoprynaline, there are:

lactose;
copovidone;
starch;
trilon B;
magnesium stearate;
glycerol;
talc.

Ginipral solution(for injections) goes on sale in hermetic ampoules of 2 ml. Each individual ampoule contains hexoprynaline at a concentration of 10 μg. They are already ready for use. Sold in a cardboard box of 5 pcs. Additionally, the drug contains:

purified water;
sodium sulfate;
disodium edetate.

Ginipral concentrate(for droppers) is a clear liquid with a high content of hexoprynaline (25 mcg). It must be diluted in liquid for injection and added to the solution for infusion. Among the excipients are:

sodium chloride;
sulfuric acid;
sodium pyrosulfate;
purified water.

The effect of Ginipral during pregnancy on the condition of the fetus

The drug is allowed during the gestation period, but it is not among the safe drugs. But in the event of hypertonicity, the use of Ginipral remains the only way to delay childbirth until a safe period and save the fetus.

Since Ginipral is actively absorbed in the intestines and instantly enters the bloodstream, it easily overcomes the placental barrier and enters the baby's blood. According to the data of the conducted studies, long-term use of hexoprenaline negatively affects cardiovascular system baby. This can cause the following consequences:

pathological heart contractions;
difficulty breathing after delivery;
heart muscle defects;
anaphylactic shock on the first day after birth;
acidosis;
bronchospasm;
reduced glucose levels.

Important! Considering possible complications, Ginipral should be taken under the supervision of a doctor in a hospital setting and with constant monitoring of the child's condition.

Ginipral during pregnancy: what is the drug prescribed for

Tocolytic therapy with Ginipral is carried out in women between 22 and 36 weeks of gestation and in the absence of gynecological or medical contraindications.

Since the degree of therapeutic effect in different forms of Ginipral is different, the spectrum of indications is different for them.

The tablet form of Ginipral is indicated for the threat of early labor and is mainly used as a continuation of injection therapy. Maintenance dosage tablets ensure the normal condition of the uterus after stabilization of the myometrium. In the presence of moderate hypertonicity, it is possible to take only the tablet form without infusions.

Ginipral in the form of a solution and concentrate is indicated for the following conditions:

Short-term treatment of preterm labor without complications.
At the stage of turning over the baby, which is in a transverse presentation.
As an emergency measure when transporting a woman in labor.

Ginipral is also used for intravenous administration in case of tocolysis in a pregnant woman:

Acute tocolysis is a decrease in the frequency of contractions between 1 and 2 contractions in the presence of severe hypoxia in the fetus. By reducing the contractions of the uterus, the vessels dilate, and the fetus receives more oxygen.
Massive tocolysis - the cessation of intense contractions with the absolute opening of the neck.
Long-term tocolysis - stopping early labor at 20-34 weeks, as well as for immobilizing the uterus with cervical cerclage (suturing the uterine cervix to preserve pregnancy).

It should be noted that the use of Ginipral in the first trimester in obstetric practice does not occur. The fact is that the receptors that the drug affects are formed closer to the 20th gestational week, so taking Ginipral in the first three months does not give the desired result and can greatly harm the fetus. Therefore, other drugs are selected to eliminate hypertonicity in the 1st trimester.

Ginipral: instructions for use during pregnancy

Ginipral is a serious drug with many contraindications and side effects. Its reception occurs according to a certain scheme under the supervision of an obstetrician-gynecologist. Therefore, self-administration of the drug, a decrease / increase in the indicated dosage, or replacement of the drug with another analogue is strictly prohibited.

Dosage of Ginipral during pregnancy: dropper and tablets

Ginipral solution is administered intravenously. It is diluted in a solution of sodium chloride to obtain 10 mg of the agent, and then slowly administered by intravenous injection. The daily dose is 2 ampoules. To stabilize the condition after the jet injection of the solution, a concentrate for infusion is prescribed at a rate of 0.3 or 0.07 mcg / min.

After the hypertonicity and the frequency of contractions return to normal, the infusions are replaced by tablets. The intake of Ginipril in tablets should correspond to the following scheme: one hour before the end of the infusion of Ginipral, 1 tablet is drunk every 3 hours for 2 days. Then every 4-6 hours, but not more than 8 tablets per day. After stabilization of the condition, the daily dose is reduced to 2 tablets. The drug is taken orally as a whole, washed down with plain water.

Ginipral during pregnancy: instructions for drug withdrawal

Abrupt discontinuation of Ginipral tablets may have the opposite effect. Therefore, the reduction or cancellation of the drug is carried out gradually.

If you need to reduce the dose, 1 tablet is removed every two days. The remaining amount is taken at regular intervals. When the dose becomes equal to 2 tablets, you need to stop reducing it. On average, the drug should be taken up to 33 weeks of pregnancy and longer. If the condition worsens, the dose of the drug is also gradually increased.

The cancellation of Ginipral occurs in this way. If the daily dose was more than 6 tablets, you need to take one tablet less after two days. When 2-3 tablets remain, you need to reduce half a tablet every two days and so on until the drug is completely discontinued.

Contraindications to the use of Ginipral

The drug is not prescribed to patients with individual intolerance to hexoprenaline. Also, a complete contraindication is a negative reaction to beta-mimetics in the form of hypertension of the lung tissue, abnormalities in the work of the heart.

Ginepral is contraindicated in the following diseases and conditions:

The transfer of any disease up to 22 gestational weeks.
The use of the drug for tocolysis in the presence of coronary heart disease.
Threatened miscarriage in the 1st and 2nd trimester.
Cervical dilatation more than 4 cm.
Rupture of the amniotic membrane.
Any dangerous disease of the mother and fetus, in which it is dangerous to maintain pregnancy (vaginal bleeding, intrauterine infection, preeclampsia, placental abruption, renal failure).
The presence in the anamnesis of intrauterine death of the child, genetic abnormalities, diseases that led to the death of the fetus in the perinatal period.
Pathology of the cardiovascular system (tachycardia, myocarditis, etc.).
Exacerbation of bronchial asthma.
Hyperthyroidism.
Glaucoma.
Damage to the kidneys and liver.

Ginipral is used with extreme caution in parturient women with sulfate intolerance.

Features of the use of Ginipral

The drug in gynecology is prescribed only after assessing the ratio of benefits / harm to the fetus and woman. Moreover, the treatment takes place only in medical institutions in order to constantly monitor the well-being of a woman and her baby.

During treatment, especially if tocolysis is prescribed, it is necessary to monitor the condition of the woman and the fetus. To do this, the following activities are carried out:

Control of heart rate and blood pressure. The entire period of taking Ginipral in a woman is accompanied by an increase in heart rate by 35-50 bpm. In order for the woman's condition to be stable, Ginipral is taken during pregnancy at a dosage that allows you to keep the contraction rate up to 120 bpm. at rest. With the intravenous administration of Ginipral, a woman's blood pressure can drop significantly, so at the time of the dropper, blood pressure indicators must be monitored.
Study of water-electrolyte balance and control of the respiratory system. Treatment with Ginipral can lead to extensive pulmonary edema. If a woman has a multiple pregnancy or is diagnosed with preeclampsia, then the risk of edema increases several times.
Measurement of glucose and lactose in the blood. Tocolytics cause an increase in glucose levels. If a woman is diabetic, the dose of stroke should be adjusted.
Prevention of hypokalemia. Ginipral affects the concentration of potassium in the blood serum. If there are clinical prerequisites for hypokalemia, therapy with potassium preparations is prescribed.

At the first symptoms of myocardial ischemia, treatment should be stopped.

Possible side effects after taking Ginipral

Widespread adverse reactions occur due to the pharmacological features of tocolytics. To prevent their occurrence, strict control of hemodynamic parameters (blood pressure, heart rate, dosage) is needed. After the end of treatment, all side effects disappear.

Against the background of taking Ginipral, the following undesirable reactions may occur:

Lipolysis (impaired fat metabolism).
Potassium deficiency.
Hyperkalemia (in patients with diabetes mellitus).
Violation of the central nervous system (tremor, headache, dizziness).
Problems with the work of the heart (tachycardia, hypotension, increased heart rate, angina pectoris).
Pulmonary edema.
Bronchospasm.
Problems in the gastrointestinal tract (nausea, constipation, impaired intestinal motility, vomiting).
Inflammation of the skin (rash, sweating, itching, redness).
Decreased daily diuresis.
Swelling of the extremities.

Pregnant women with asthma may become severely ill and may experience symptoms such as:

Protracted asthmatic attack.
Whistling during inhalation/exhalation.
Confused mind, shock.
Nausea, diarrhea.

Important! If Ginipral was used on the eve of childbirth, the newborn should be examined for hypokalemia and acidosis (ketone bodies).

What can replace Ginipral during pregnancy?

The pharmaceutical industry produces several analogues of Ginipral. Some of them have the same composition. These include Ipradol and Hexoprenaline. And there are also drugs with a different composition, but similar therapeutic properties - Magnesia, Salbutamol and Partusitsen.

Ginipral during pregnancy - reviews

Feedback on the drug Ginipral is mostly positive, because for pregnant women who were treated, he helped save the baby, postponing early birth. All positive reviews concern precisely its rapid therapeutic effect and the ability to instantly eliminate intense uterine contractions, removing the threat of premature delivery.

However, among the positive qualities of the drug, women distinguish a number of disadvantages. Ginipral provoked side effects in almost all patients. But severe discomfort was noted only during the first 45 minutes after ingestion, and then passed without a trace. But such disadvantages of Ginipral are acceptable, especially against the background of the high efficiency of the remedy.

Thus, Ginipral is considered an active drug that allows a woman to bring her baby to a safe line.

How is childbirth going after taking Ginipral?

In women taking Ginipral, the process of delivery is different. The vast majority of women in labor successfully wait for contractions, and then give birth to babies calmly and without complications. This situation is typical for women who have been treated for severe uterine hypertension. As a rule, labor activity intensified, 3 weeks after the abolition of Ginipral.

A smaller number of women reach the 42nd gestational week, and without waiting for contractions, they are hospitalized. There, they stimulate the birth process in suitable ways. Often, against the background of full disclosure of the cervix and the absence of contractions, an emergency caesarean section is performed.

Despite the large list of contraindications and the risk of weak labor activity, Ginipral is considered one of the most effective tocolytic agents. Sometimes this drug is the only way to keep the pregnancy going. Therefore, if you are prescribed it, it is better to heed the advice of a doctor.

Ginipral and pregnancy. Video

For various reasons, pregnancy does not always go well. The tone of the uterus is familiar to many women in position, but sometimes there are more serious situations that really threaten childbirth ahead of schedule, to prevent which Ginipral is often prescribed in Russia.

Action Ginipral

Ginipral is a modern tocolytic drug that affects the contractile activity of smooth muscles and reduces muscle tone. The active substance of the drug hexoprenaline selectively stimulates β2-type adrenoreceptors located in all muscles of the body: the uterus, heart, skeletal muscle tissues, as well as in the bronchi, liver and other organs. Ginipral allows you to save pregnancy, delay preterm birth until full-term or for the period necessary to take emergency measures.

Due to the selective (selective) principle of action, side effects from the use of Ginipral are less common compared to non-selective drugs that simultaneously affect different types body tissue receptors.

From what week of pregnancy and why is it prescribed

This tool is actively used to prevent premature birth. Ginipral is used as monotherapy, since its simultaneous use with other similar drugs increases the risk of side effects by several times. The drug is allowed for pregnant women starting from the second half of the second trimester. Earlier than 24–25 weeks, it is ineffective, since the uterine receptors, which are affected by the drug, become sensitive only by this time.

Normal tone in the first half of pregnancy is supported by hormonal therapy.

Increased uterine tone and other indications for droppers and tablets

Ginipral tablets are prescribed once or as a course for women with increased uterine tone with premature smoothing and opening of the cervix as a means to prevent early childbirth. Usually they are used to continue therapy after a course of intravenous administration of a solution, but they can also be used separately from it - on an outpatient basis, that is, at home.

In a hospital, if a woman is placed in storage or brought to the hospital by ambulance, a solution is prescribed for intravenous administration through droppers. If 48 hours after the start of treatment there is no recurrence of contractions, then the pregnancy continues to be maintained by taking Ginipral in the form of tablets.

IN special occasions tablets and droppers are prescribed simultaneously: the tablet is taken shortly before the end of the intravenous solution.

In the case of childbirth, yet begun prematurely, Ginipral's solution is prescribed:

for the prevention of contractions, when there are strong and very frequent uterine contractions without smoothing the cervix or opening the pharynx;
to inhibit contractions with a smoothed cervix and / or opening of the cervix of the uterus;
as an emergency measure before taking the pregnant woman to the hospital.

The drug is also used during timely delivery in order to stop contractions in the following situations:

with obstructed blood flow to the fetus;
with prolapse of the umbilical cord;
with complicated labor activity;
before caesarean section;
before turning the fetus from a transverse position to relax the muscles of the uterus.

The use of Ginipral as a means of relaxing the muscles of the uterus is also necessary in the case of suturing the short neck before the operation, during and after the procedure.

The drug is administered very slowly, about 5-6 hours.

What the experts say

Among all the available tocolytics intended to prevent preterm labor and maintain pregnancy, most domestic specialists prefer beta2-adrenergic agonists, in particular, Ginipral.

Based on the long-term use of Ginipral, it has been established that the effectiveness of its use is about 90%.

Serov V. N., Tyutyunnik V. L., publication in Russian medical journal
http://www.rmj.ru/articles/pediatriya/Taktika_lecheniya_ugroghayuschih_preghdevremennyh_rodov/#ixzz4FVFgXzN7

Despite popular belief, doctors say that the drug does not affect the course of childbirth. After its cancellation, the possibility of natural delivery without complications returns to the woman.

Contraindications

The appointment of hexoprenaline is prohibited for women with:

thyrotoxicosis;
tachyarrhythmias;
myocarditis;
mitral valve disease and aortic stenosis;
ischemic heart disease;
arterial hypertension;
severe diseases of the liver and kidneys;
angle-closure glaucoma;
uterine bleeding, premature detachment of the placenta;
chorioamnionitis and other intrauterine infections;
I trimester of pregnancy;
lactation (breastfeeding);
hypersensitivity to the components of the drug (especially in patients with bronchial asthma and a history of hypersensitivity to sulfites).

Gap amniotic sac and the opening of the cervix by more than 3 cm greatly reduce the effectiveness of Ginipral.

Side effects and effects on the fetus

During treatment, the following undesirable reactions of the body are possible:

headache, dizziness;
feeling of anxiety, trembling fingers;
decrease in blood pressure, an increase in the heart rate in the mother (while the heart rate in the child, as a rule, does not change), heart rhythm disturbances, chest pain, which disappear after stopping the use of the drug;
nausea, vomiting, bowel problems, intestinal obstruction, a temporary jump in the level of liver enzymes in the blood;
difficulty breathing, bronchospasm, pulmonary edema, impaired consciousness up to coma, anaphylactic shock (in patients with bronchial asthma or patients with hypersensitivity to sulfites);
lack of potassium and calcium at the beginning of therapy, increased blood sugar levels;
sweating, decrease in the amount of urine produced, edema (especially in patients with kidney disease).

The frequency of side effects directly depends on the dose of the drug, therefore, if the above symptoms appear, it may be necessary to adjust the prescribed treatment.

In a newborn, as a result of the treatment of the mother with Ginipral, the blood sugar level can be reduced, and the acid-base balance of the body is shifted to the acid side.

Despite the many side effects, thanks to Ginipral, it becomes possible to prevent or delay preterm birth for the period necessary to transfer a woman to perinatal center and acceleration of fetal lung maturation.

How to use and properly cancel the drug

Ginipral can be used both for a long time (up to several months) to eliminate the threat of preterm labor, and once, if there are specific indications. The dose of the drug and the treatment regimen is always selected individually.. The doses recommended in the instructions are indicative information for specialists. Reduction of the prescribed dose and further complete withdrawal of the drug is carried out by the doctor only 5-7 days after the elimination of the threat of termination of pregnancy, as well as in the case of:

difficult breathing;
significant changes in blood pressure, chest pain, suspicion of heart failure;
hypersensitivity.

It is necessary to cancel the drug not abruptly, but gradually reducing the dose. If you abruptly stop drinking pills, this can lead to the reappearance of uterine hypertonicity.

Risk Mitigation Instructions

Due to the fact that Ginipral has a significant effect on the body as a whole, a number of preventive measures must be taken during treatment.

In connection with the effect of the drug on the cardiovascular system, it is necessary to monitor the pressure and heart rate of both the mother and the fetus. If necessary, the control of the heart is carried out using an ECG.
In the first days of treatment, there is a high probability of an increase in blood sugar levels, therefore, in women with diabetes, carbohydrate metabolism indicators are carefully checked to rule out hyperglycemia.
A decrease in diuresis makes it necessary to monitor the appearance of symptoms that indicate fluid retention in the body.
During treatment with Ginipral, excessive fluid and salt intake should be limited.
Due to the effect on intestinal motility, it is recommended to pay attention to the regularity of the stool.
Control of the normal functioning of the lungs, the absence of noise, swelling of the bronchi is needed, since Ginipral also affects the pulmonary muscles.
In parallel with Ginipral, potassium preparations and agents for the prevention of heart disorders, for example, Verapamil, are often prescribed.
Tea and coffee during treatment with Ginipral may increase the body's adverse reactions to the drug.
In case of hypersensitivity to sympathomimetics, Ginipral is prescribed in small doses and with constant monitoring of the woman's condition by the doctor.

Why the doctor can cancel Ginipral and how to replace it

Treatment tactics aimed at preventing preterm labor depend on the duration of pregnancy, the condition of the mother and child, the integrity of the amniotic sac, the nature of contractions of the muscles of the uterus, the degree of readiness of the cervix for childbirth, the presence and severity of bleeding. Depending on these indicators, certain drugs are prescribed.

Ginipral causes many side effects, besides, it must be prescribed carefully due to the impressive list of contraindications. Therefore, some doctors in their practice use drugs based on fenoterol (for example, Partusisten).

Magnesium sulfate (magnesium) known to many is widely used in domestic medicine, despite the absence of a pronounced tocolytic effect. But in guidelines The Ministry of Health of the Russian Federation for the management of preterm labor, it is not recommended as a means of reducing the frequency and intensity of uterine contractions.

Last update of the description by the manufacturer 30.09.2011

Filterable List

Active substance:

ATX

Pharmacological groups

Nosological classification (ICD-10)

3D images

Composition and form of release

in blister PVC/Al. 10 pieces.; in a pack of cardboard 1 or 2 blisters.

Description of the dosage form

Pills: white, round, biconvex.

pharmachologic effect

pharmachologic effect- tocolytic.

Pharmacodynamics

Relaxes the muscles of the uterus, reduces the frequency and intensity of contractions, inhibits spontaneous and oxytocin-induced labor pains. During childbirth, it normalizes the strength and regularity of contractions, inhibits (in most cases) premature contractions and helps to prolong pregnancy until the normal term of childbirth. Slightly affects the cardiovascular system of the pregnant woman and the fetus.

Pharmacokinetics

When taken orally, it is well absorbed. It is excreted in the form of a dimethylated derivative with urine and with bile - in the form of complex metabolites.

Ginipral ® consists of 2 catecholamine groups, which are methylated in the human body by catecholamine-O-methyltransferase. Hexoprenaline becomes biologically inactive only if both of its catecholamine groups are methylated. With intrabronchial administration, 3 H-labeled hexoprenaline is excreted in the urine in the form of a biologically active substance for a relatively long time. Part of the injected substance remains active at the injection site for quite a long time.

Indications of the drug Ginipral ®

The threat of premature birth (as a continuation of infusion therapy).

Contraindications

hypersensitivity (especially in patients suffering from bronchial asthma and hypersensitivity to sulfites);

thyrotoxicosis;

cardiovascular diseases, especially cardiac arrhythmias occurring with tachycardia; myocarditis, mitral valve disease and aortic stenosis;

arterial hypertension;

severe liver and kidney disease;

angle-closure glaucoma;

premature detachment of the placenta, uterine bleeding, intrauterine infections;

pregnancy (I trimester);

lactation period.

Use during pregnancy and lactation

Contraindicated in the first trimester of pregnancy. At the time of treatment should stop breastfeeding.

Side effects

Dizziness, anxiety, slight tremor of the fingers, increased sweating, tachycardia, headache, increased activity of liver enzymes.

There may be a decrease in blood pressure, especially diastolic. In some cases, nausea and vomiting develop.

In rare cases - ventricular extrasystole, pain in the region of the heart (cardialgia). These symptoms quickly disappear after discontinuation of the drug.

The level of sugar in the blood rises due to the glycogenolytic action of the drug (especially in diabetes).

Diuresis at the beginning of treatment is reduced. In patients with a tendency to fluid retention in the tissues, this can lead to edema.

During treatment with Ginipral ®, the intensity of intestinal motility may decrease (it is necessary to pay attention to the regularity of the stool).

In newborns - hypoglycemia, acidosis, bronchospasm, anaphylactic shock.

Interaction

A number of drugs that reduce blood pressure (β-blockers) weaken the effect of Ginipral ® or neutralize it.

Methylxanthines (eg theophylline) enhance the effect of Ginipral ® .

The effect of oral hypoglycemic agents during Ginipral ® therapy is weakened.

General anesthetics (halothane) and adrenostimulants (cardiovascular and anti-asthma drugs) increase cardiovascular side effects.

Ginipral ® is incompatible with ergot alkaloid, MAO inhibitors, tricyclic antidepressants, as well as with mineralocorticoids, dihydrotachysterol and preparations containing calcium and vitamin D.

Dosage and administration

inside with a small amount of water.

Threat of preterm birth: 1-2 hours before the end of the Ginipral infusion, start taking tablets at a dose of 0.5 mg (1 tablet) every 3 hours, then every 4-6 hours (4-8 tablets per day).

Overdose

Symptoms: anxiety, tremor, increased sweating, severe tachycardia, arrhythmia, headaches, cardialgia, decreased blood pressure, shortness of breath.

Treatment: the use of Ginipral ® antagonists - non-selective β-blockers, completely neutralizing its effect.

special instructions

Blood pressure, pulse and cardiac activity should be under constant medical supervision.

In patients with diabetes, blood sugar levels should be monitored.

Under the influence of Ginipral ®, diuresis decreases, so you should carefully monitor the symptoms that reflect fluid retention in the body (for example, swelling of the legs, shortness of breath). This is especially important in the case of simultaneous administration of corticosteroids or kidney disease.

Strict restriction of excess fluid intake is necessary.

Dietary salt intake should be limited.

In the process of tocolytic treatment, it is necessary to control bowel movements.

With prolonged tocolytic therapy, it is necessary to monitor the state of the fetoplacental complex. With a rupture of the fetal bladder and with the opening of the cervix by more than 2-3 cm, the effectiveness of tocolytic therapy is low.

If it is necessary to carry out an operative intervention, the anesthesiologist should be informed about Ginipral ® therapy.

It is necessary to take into account the intake of any other drugs in case of prescribing Ginipral ® therapy.

Coffee and tea may increase the side effects of Ginipral ® .

You should immediately inform the doctor about contraindications or the development of side effects.

Terms of dispensing from pharmacies

On prescription.

Storage conditions of the drug Ginipral ®

In a place protected from light, at a temperature not exceeding 25 ° C.

Keep out of the reach of children.

Shelf life of the drug Ginipral ®

5 years.

Do not use after the expiry date stated on the packaging.

Synonyms of nosological groups

Category ICD-10	Synonyms of diseases according to ICD-10
O34.3 Isthmic-cervical insufficiency requiring presentation medical care mothers	cervical cerclage
O60 Premature birth	Pregnancy premature
	Immobilization of the uterus
	Immobilization of the uterus before caesarean section
	Acute tocolysis
	Prevention of preterm birth
	Premature discharge of water
	Premature labor pains
	Pre-hospital contractions
	Childbirth premature
	Threatened preterm birth
	Threat of preterm birth
O62.3 Rapid labor	Acute tocolysis
O62.4 Hypertonic, uncoordinated and prolonged uterine contractions	Uterine hypertonicity
	Spasm of the cervix
O66.9 Obstructed labor, unspecified	Complicated labor activity
P20.9 Intrauterine hypoxia, unspecified	Acute intrauterine asphyxia
P20.9 Intrauterine hypoxia, unspecified	Acute intrauterine fetal asphyxia