A patient at 41 weeks with oligohydramnios (AFI 4 cm) and a Bishop score of 4 requires cervical ripening. Which method has evidence for both cervical ripening and reducing the need for oxytocin augmentation in post-term pregnancy?
- A Misoprostol 25 mcg intravaginal every 4 hours
- B Dinoprostone 10 mg sustained release vaginal insert ✓
- C Foley catheter transcervical balloon
- D Hygroscopic dilators (laminaria)
Correct answer: B. Dinoprostone 10 mg sustained release vaginal insert
Explanation
The Cervidil (dinoprostone 10 mg sustained-release insert) provides continuous controlled prostaglandin E2 release over 12 hours, promoting cervical ripening and often initiating contractions, reducing the need for subsequent oxytocin. It has the advantage of being removable if uterine tachysystole occurs. Misoprostol (25 mcg) is also effective but with oligohydramnios it requires particular caution due to hyperstimulation risk; the Foley catheter is purely mechanical without prostaglandin effects. Laminaria act slowly and are more commonly used for second-trimester procedures.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.