A 31-year-old G2P1 with one previous lower segment cesarean section is at 40 weeks with a Bishop score of 4. Induction is planned. Which method of cervical ripening is MOST appropriate?

• A Transcervical Foley catheter ✓
• B Dinoprostone vaginal pessary
• C High-dose oxytocin infusion alone
• D Mifepristone orally

Explanation

Mechanical methods such as a transcervical Foley catheter are preferred for ripening an unfavourable cervix in a woman with a prior cesarean because they carry minimal risk of uterine hyperstimulation and scar rupture. Prostaglandins, particularly dinoprostone and misoprostol, increase the risk of tachysystole and uterine rupture in a scarred uterus and are generally avoided. Mifepristone is not used for term cervical ripening. Oxytocin alone is ineffective on an unripe cervix.

Reference: RCOG Green-top Guideline No. 29a, Third edition ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.