A primigravida at 41+3 weeks is undergoing induction of labour. Her Bishop score is calculated: cervical dilatation 1 cm (1 point), effacement 40% (1 point), consistency firm (0 points), position posterior (0 points), station -3 (0 points). Total Bishop score = 2. The MOST appropriate initial induction method is:

• A Artificial rupture of membranes (ARM)
• B IV oxytocin infusion
• C Oral mifepristone 200 mg
• D Intracervical dinoprostone gel 0.5 mg ✓

Explanation

Bishop score 2 indicates an unfavourable cervix (score < 6 is unfavourable). ARM and IV oxytocin require a favourable/ripe cervix (Bishop ≥ 6). Cervical ripening must precede oxytocin. Intracervical PGE2 (dinoprostone) gel 0.5 mg is a standard cervical ripening agent for unfavourable cervix prior to induction. Mifepristone for induction at term is used in some protocols but intracervical/vaginal PGE2 is the standard first-line ripening agent per ACOG and NICE.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.