Cerviprime (Dinoprostone) Gel Placement
No, Cerviprime gel should NOT be inserted between the internal and external os—it should be placed into the cervical canal just below the level of the internal os. 1
Correct Administration Technique
The FDA-approved labeling for dinoprostone gel (PREPIDIL) provides explicit instructions for proper placement 1:
- Using sterile technique, introduce the gel with the catheter provided into the cervical canal just below the level of the internal os 1
- The gel is administered by gentle expulsion from the syringe, then the catheter is removed 1
- The patient should remain supine for at least 15-30 minutes after administration to minimize leakage from the cervical canal 1
Catheter Selection Based on Cervical Effacement
Careful vaginal examination determines which catheter length to use 1:
- 20 mm endocervical catheter: Use when no effacement is present 1
- 10 mm catheter: Use when the cervix is 50% effaced 1
This catheter selection ensures the gel reaches the appropriate depth in the cervical canal relative to the degree of cervical ripening already present.
Key Safety Considerations
Handle with caution to prevent skin contact—wash hands thoroughly with soap and water after administration 1. The gel should be brought to room temperature (59° to 86°F) just prior to use, but never force warming with a water bath or microwave 1.
Fill the catheter with gel by pushing the plunger to expel air before patient administration 1. Use contents of one syringe for one patient only, and discard the syringe, catheter, and unused contents after use 1.
Dosing Parameters
- Initial dose: 0.5 mg dinoprostone 1
- If no cervical/uterine response occurs, repeat dosing may be given at 6-hour intervals 1
- Maximum cumulative dose in 24 hours: 1.5 mg dinoprostone (7.5 mL gel) 1
- Recommended interval before oxytocin administration: 6-12 hours if desired response is obtained 1
Common Pitfall to Avoid
Do not attempt to place the gel "between" the internal and external os—this misunderstands the anatomy and proper technique. The cervical canal is a continuous space, and the gel should be deposited into this canal just below (inferior to) the internal os, not somehow positioned in the middle of the canal 1.