A woman at 41+3 weeks is being considered for induction of labour. Her Bishop score is 3. Which of the following is the MOST appropriate cervical ripening agent considering her intact membranes and no contraindication to prostaglandins?

• A Oxytocin infusion
• B Misoprostol (PGE1) 25 mcg vaginal
• C Balloon catheter (Foley catheter) for mechanical ripening
• D Dinoprostone (PGE2) slow-release vaginal insert (Cervidil) ✓

Explanation

For cervical ripening with an unfavorable cervix (Bishop score <6), prostaglandins are superior to oxytocin alone. Dinoprostone slow-release vaginal insert (Cervidil, 10 mg PGE2) is a controlled-release preparation that can be removed if uterine hyperstimulation occurs, providing a safety advantage. Misoprostol 25 mcg vaginally is also effective and widely used. The choice between them depends on institutional protocol; Cervidil is preferred where removal capability is important. Oxytocin alone without prior cervical ripening is inappropriate with a Bishop score of 3.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.