A 31-year-old G2P1 with one previous uncomplicated lower segment caesarean section is now at 41 weeks with an unfavourable cervix and requires induction. Which cervical ripening method is most appropriate?

• A Vaginal dinoprostone pessary
• B Transcervical Foley catheter ✓
• C Vaginal misoprostol 50 micrograms
• D Intravenous oxytocin alone without ripening

Explanation

Prostaglandins are avoided for cervical ripening after a previous caesarean because they markedly increase the risk of uterine rupture, and this caution applies to both dinoprostone and misoprostol. Mechanical methods such as a transcervical Foley balloon achieve comparable ripening without increasing contractile tone dangerously, making them the preferred choice in this setting. Oxytocin alone is less effective on an unfavourable cervix and is typically used after ripening or once membranes are ruptured.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.