A primigravida at 41+2 weeks has a Bishop score of 3. She is scheduled for cervical ripening. Her Bishop score components are: cervical dilation 0 cm (0 points), effacement 30% (0 points), consistency firm (0 points), position posterior (0 points), station -3 (1 point). The modified Bishop score is 1. The most appropriate cervical ripening agent with the best evidence for outpatient use and lowest uterine hyperstimulation risk at term in this scenario is:

• A Intravaginal dinoprostone 10 mg pessary (Cervidil)
• B Intravaginal misoprostol 25 µg every 6 hours
• C Oral mifepristone 200 mg followed by misoprostol
• D Transcervical Foley catheter balloon ✓

Explanation

A Foley catheter balloon (mechanical cervical ripening) has the lowest risk of uterine hyperstimulation (tachysystole) because it acts mechanically by releasing prostaglandins from the lower uterine segment and does not deliver exogenous uterotonics. It is safe for outpatient ripening and suitable for unfavorable cervices. Dinoprostone and misoprostol carry higher risk of uterine hyperstimulation, particularly in a post-dates primigravida, and require inpatient fetal monitoring. Mifepristone-misoprostol is used in termination contexts rather than routine post-dates induction.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.