A G3P2 with one previous lower segment cesarean section at 39 weeks requires induction of labor for severe pre-eclampsia. Her cervix is unfavourable. Which cervical ripening method is MOST appropriate?

• A Transcervical Foley catheter with extra-amniotic saline infusion ✓
• B Intracervical dinoprostone gel
• C Vaginal misoprostol 25 microgram 6-hourly
• D Concentrated oxytocin infusion alone until labour starts

Explanation

Mechanical methods such as a transcervical Foley catheter achieve ripening without provoking uterine hyperstimulation, which matters because hyperstimulation carries uterine rupture risk in a scarred uterus. Prostaglandins, including low-dose vaginal misoprostol and dinoprostone, are avoided or used with extreme caution after a previous cesarean. Oxytocin alone is poor at ripening an unfavourable cervix and is mainly useful when the Bishop score is already favourable.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.