A 29-year-old G2P1 at 41 weeks is undergoing labour induction for post-term pregnancy. She has a Bishop score of 4. Following cervical ripening with dinoprostone, her cervix is now 2 cm dilated, 50% effaced, station -1, medium consistency, posterior position (Bishop score 6). Which is the most appropriate next step?
- A Repeat dinoprostone and await for Bishop score ≥ 8
- B Oxytocin infusion with or without ARM ✓
- C Artificial rupture of membranes (ARM) alone
- D Proceed to cesarean section for failed cervical ripening
Explanation
A Bishop score of 6 indicates a partially favourable cervix — sufficient for proceeding to oxytocin augmentation. ACOG and RCOG guidelines recommend oxytocin infusion (with or without ARM) once the Bishop score is ≥ 6 after cervical ripening. Repeating dinoprostone is unnecessary (and may cause hyperstimulation if oxytocin follows too soon without adequate washout period). ARM alone without oxytocin is insufficient for induction in a partially ripened cervix. Cesarean section is not indicated for a Bishop score of 6 after ripening — failed induction is defined as inadequate cervical change despite ≥ 12–18 hours of adequate oxytocin.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.