A woman at 40+5 weeks has a Bishop score of 6. She undergoes induction with low-dose oxytocin. After 8 hours she is 3 cm dilated. CTG is reactive. What is the most appropriate next step?

• A Declare failed induction and proceed to cesarean section
• B Administer sublingual misoprostol 25 µg every 2 hours
• C Stop oxytocin, allow 12-hour rest, restart next morning
• D Perform artificial rupture of membranes (ARM) if head is well applied ✓

Explanation

Once the cervix reaches 3 cm (early active phase) during induction with oxytocin, amniotomy (artificial rupture of membranes) augments labour by releasing prostaglandins and improving head application to the cervix. Declaring failed induction requires at least 12–18 hours of adequate contractions after membrane rupture. Misoprostol is not added to oxytocin due to hyperstimulation risk. Rest-and-restart is not standard once active phase is entered.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.