Patient selection:
	Patient is afebrile.
	No active vaginal bleeding is present.
	Fetal heart rate tracing is reassuring.
	Patient gives informed consent.
	Bishop score is < 4.
Bring gel to room temperature before application, per manufacturer's instructions.
Monitor fetal heart rate and uterine activity continuously starting 15 to 30 minutes before gel introduction and continuing for 30 to 120 minutes after gel insertion.
Introduce the gel into the cervix as follows:
	If the cervix is uneffaced, use the 20-mm endocervical catheter to introduce the gel into the endocervix just below the level of the internal os.
	If the cervix is 50 percent effaced, use the 10-mm endocervical catheter.
After application of the gel, the patient should remain recumbent for 30 minutes before being allowed to ambulate.
May repeat every six hours, up to three doses in 24 hours.
End points for ripening include strong uterine contractions, a Bishop score of 8, or a change in maternal or fetal status.
Maximum recommended dosage is 1.5 mg of dinoprostone (3 doses) in 24 hours.
Do not start oxytocin for six to 12 hours after placement of the last dose, to allow for spontaneous onset of labor and protect the uterus from overstimulation.