A woman at 41+3 weeks gestation has an unfavorable cervix (Bishop score 3). She is scheduled for induction of labour. What is the MOST appropriate initial cervical ripening agent?

• A Intravaginal misoprostol 25 mcg 6-hourly ✓
• B Intravenous oxytocin infusion
• C Dinoprostone gel intracervically
• D Amniotomy alone

Explanation

For cervical ripening with an unfavorable cervix (Bishop score <6), prostaglandins are preferred over oxytocin alone. Low-dose intravaginal misoprostol (25 mcg 6-hourly) is recommended by WHO and widely used due to its efficacy, low cost, and stability at room temperature. Dinoprostone is also acceptable but more expensive. Oxytocin alone is insufficient for an unfavorable cervix. Amniotomy cannot be performed with an unripe, closed cervix.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.