A primigravida at 41+3 weeks is post-dates. The Bishop score is 3. Which of the following cervical ripening agents is MOST appropriate if she is not in active labour?

• A Oxytocin IV infusion at 2–4 mU/min
• B Dinoprostone (PGE2) pessary 10 mg vaginal ✓
• C Misoprostol 25 mcg oral every 2 hours
• D Foley catheter balloon with concurrent oxytocin

Explanation

For an unfavourable cervix (Bishop score ≤6) requiring ripening before induction, prostaglandins are first-line agents. Dinoprostone 10 mg vaginal pessary provides slow-release PGE2 over 24 hours and has the advantage of easy removal (pull-out) if hyperstimulation occurs. Misoprostol is equally effective but the 25 mcg vaginal or oral dose is used — both are acceptable, though the pessary is more easily controlled. Oxytocin alone is ineffective on an unripe cervix (Bishop score 3). Foley balloon is a mechanical method used as alternative to prostaglandins or in cases where prostaglandins are contraindicated (e.g., prior uterine scar).

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.