A woman has a previous lower segment cesarean section (LSCS) and is at 39 weeks with an unfavorable cervix (Bishop score 3). Her obstetrician plans induction of labor for post-dates concern. Which cervical ripening agent is CONTRAINDICATED in this setting?
- A Foley catheter mechanical ripening
- B Misoprostol (PGE1) intravaginal ✓
- C Dinoprostone (PGE2) vaginal insert
- D Oxytocin alone after Foley catheter
Correct answer: B. Misoprostol (PGE1) intravaginal
Explanation
Misoprostol (PGE1) is absolutely contraindicated for cervical ripening or labor induction in women with a previous uterine scar, including prior LSCS, due to significantly increased risk of uterine rupture. Dinoprostone (PGE2) insert/gel is also generally avoided but considered relatively contraindicated (not absolute) by some guidelines. Foley catheter mechanical ripening is the safest method for cervical ripening in women with a uterine scar.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.