A G3P2 at 40 weeks with an unfavorable cervix requires induction. She has one previous lower segment cesarean section two years ago for fetal distress. Which cervical ripening method is MOST appropriate?

• A Vaginal misoprostol 25 micrograms 4-hourly
• B Transcervical Foley catheter balloon ripening followed by oxytocin ✓
• C Intracervical dinoprostone gel repeated 6-hourly
• D Oral mifepristone priming followed by oxytocin infusion

Explanation

After a previous cesarean, mechanical ripening with a transcervical balloon catheter is preferred because it ripens the cervix without provoking the sustained uterine activity that raises scar rupture risk with prostaglandins. Both misoprostol and dinoprostone are relatively or absolutely avoided with a scarred uterus; Indian exam convention treats prostaglandin use after cesarean as contraindicated. Mifepristone has no established role in term induction. Oxytocin alone may be added once ripening is achieved.

Reference: Fernando Arias' Practical Guide to High-Risk Pregnancy and Delivery, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.