A 26-year-old primigravida at 41 weeks has a Bishop score of 4. Which of the following is the MOST appropriate cervical ripening agent to use in an outpatient or low-intensity monitoring setting, given that uterine hyperstimulation should be rapidly reversible?
- A Misoprostol 25 µg vaginal tablet
- B Intravenous oxytocin infusion
- C Dinoprostone controlled-release pessary (Cervidil) ✓
- D Oral mifepristone alone
Correct answer: C. Dinoprostone controlled-release pessary (Cervidil)
Explanation
Dinoprostone controlled-release pessary (10 mg, Cervidil) releases PGE2 slowly over 12 hours and has the key advantage of easy removal if uterine hyperstimulation occurs, making it suitable for monitored outpatient or low-intensity inpatient settings. Misoprostol 25 µg vaginally is effective but irreversible once absorbed. IV oxytocin requires established labour and IV access. Mifepristone alone is insufficient for cervical ripening in late term induction without a subsequent prostaglandin.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.