Contraindicated in:

• Hypersensitivity to prostaglandins or additives in the gel or suppository;
• Should be avoided in situations in which prolonged uterine contractions should be avoided, including:
  • Previous cesarean section or uterine surgery;
  • Cephalopelvic disproportion;
  • Traumatic delivery or difficult labor;
  • Multiparity (≥6 term pregnancies);
  • Hyperactive or hypertonic uterus;
  • Fetal distress (if delivery is not imminent);
  • Unexplained vaginal bleeding;
  • Placenta previa;
  • Vasa previa;
  • Active herpes genitalis;
  • Obstetric emergency requiring surgical intervention;
  • Situations in which vaginal delivery is contraindicated;
• Presence of acute pelvic inflammatory disease or ruptured membranes;
• Concurrent oxytocic therapy (wait for 30 min after removing insert before using oxytocin).

Use Cautiously in:

• Uterine scarring;
• Asthma;
• Hypotension;
• Cardiac disease;
• Adrenal disorders;
• Anemia;
• Jaundice;
• Diabetes mellitus;
• Seizure disorders;
• Glaucoma;
• Renal impairment;
• Hepatic impairment;
• Pulmonary disease;
• Multiparity (up to five previous term pregnancies);
• Women >30 yr, those with complications during pregnancy, and those with a gestational age >40 wk (↑ risk of disseminated intravascular coagulation).