1. Local administration of prostaglandins to the vagina or the endocervix is the route of choice because of fewer side effects and acceptable clinical response. Uncommon side effects include fever, chills, vomiting, and diarrhea.

2. Prepidil contains 0.5 mg of dinoprostone in 2.5 mL of gel for intracervical administration. The dose can be repeated in 6 to 12 hours if there is inadequate cervical change and minimal uterine activity following the first dose. The maximum cumulative dose is 1.5 mg (ie, 3 doses) within a 24-hour period. The time interval between the final dose and initiation of oxytocin should be 6 to 12 hours because of the potential for uterine hyperstimulation with concurrent oxytocin and prostaglandin administration.

3. Cervidil is a vaginal insert containing 10 mg of dinoprostone in a timed-release formulation. The vaginal insert administers the medication at 0.3 mg/h and should be left in place for 12 hours. Oxytocin may be initiated 30 to 60 minutes after removal of the insert.

4. An advantage of the vaginal insert over the gel formulation is that the insert can be removed in cases of uterine hyperstimulation or abnormalities of the fetal heart rate tracing.

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