A 27-year-old G1P0 at 40 weeks with an unfavorable cervix (Bishop score 4) is planned for induction. She has well-controlled gestational diabetes on insulin. Which cervical ripening method is most appropriate?
- A Misoprostol 50 mcg vaginally every 4 hours
- B Mechanical dilatation with Foley catheter
- C Dinoprostone (PGE2) sustained-release insert (Cervidil) ✓
- D Oxytocin infusion without cervical ripening
Correct answer: C. Dinoprostone (PGE2) sustained-release insert (Cervidil)
Explanation
Dinoprostone sustained-release vaginal insert (Cervidil) is a preferred agent for cervical ripening with an unfavorable cervix, particularly in gestational diabetes, as it can be removed if tachysystole or hyperstimulation occurs. Misoprostol 25 mcg is also used but 50 mcg is associated with higher rates of tachysystole. Mechanical methods (Foley) are safe but dinoprostone is commonly preferred when the Bishop score is around 4. Oxytocin without ripening in an unfavorable cervix has a high failure rate and is not recommended.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.