PHARMACOLOGIC METHODS
This prostaglandin E1 analogue can be administered orally, vaginally, or sublingually for cervical ripening.
misoprostol
The most commonly used mechanical method for cervical ripening.
What is a balloon catheter?
ACOG's recommendation strength for using combination (pharmacologic + mechanical) methods to shorten time from admission to delivery.
What is a conditional recommendation (with high-quality evidence)?
Misoprostol and dinoprostone are both contraindicated in patients with this type of surgical history.
What is a history of uterine surgery (uterine scar), including prior cesarean delivery?
The physician who originally developed the scoring system used to evaluate cervical readiness for labor, in 1964.
Who is Dr. Edward Bishop?
This route of misoprostol delivery has been found to be more effective
What is vaginal delivery over oral.
Mechanical dilators promote cervical ripening by creating direct pressure and causing an increase in this substance's release.
What are prostaglandins?
The combination method found to be the most effective and safest strategy in a network meta-analysis of over 40,000 participants.
What is a Foley balloon inflated to 30 mL plus vaginal misoprostol 25 micrograms?
This is defined as more than five contractions in 10 minutes, averaged over a 30-minute interval.
What is tachysystole?
The five components assessed in the Bishop Score.
What are cervical dilation, position, effacement, station, and consistency?
The two dinoprostone preparations available in the United States.
What are the vaginal gel (0.5 mg) and the vaginal insert (10 mg)?
These dilators, made from seaweed or synthetic materials, are less commonly used in current clinical practice.
What are osmotic (hygroscopic) dilators?
The two combination methods listed in the ACOG guideline's summary box.
What are balloon catheter plus misoprostol, and balloon catheter plus oxytocin?
The type of misoprostol dosing that ACOG recommends over titrated dosing, due to fewer side effects and lower complication rates.
What is static dosing?
Is more expensive and needs to be in a refrigorator
What is dino?
The maximum cumulative dose of dinoprostone cervical gel recommended by the manufacturer within a 24-hour period.
What is 1.5 mg (three doses)?
According to the evidence, the efficacy of single-balloon and double-balloon catheters is described as this.
What is similar?
The primary benefit of combination methods over single-agent methods, according to multiple meta-analyses.
What is shorter time to vaginal delivery?
In the ARRIVE trial, the median duration of stay on labor and delivery for the induction group was this many hours.
What is 20 hours?
The range of Bishop score thresholds that have been used in studies to define an unfavorable cervix warranting cervical ripening.
What is 3 to 8?
According to a 2021 Cochrane review, oral misoprostol was associated with less of this complication compared with vaginal misoprostol, occurring at 3.9% vs 5.7%.
What is tachysystole with fetal heart rate changes?
A key advantage of mechanical methods over pharmacologic methods is this safety profile characteristic, which makes them suitable for patients who cannot receive prostaglandins.
What is a lower risk of uterine tachysystole (and they can be used in patients with uterine scars)?
A limitation of the network meta-analysis supporting combination therapy was the inability to assess increased risk of this infectious complication.
What is chorioamnionitis?
A starting dose of this amount of misoprostol may offer the best balance of achieving vaginal delivery and lower tachysystole rates, per a 2021 Cochrane subgroup analysis.
What is 25 micrograms?
This antiprogesterone agent has been investigated for cervical ripening but appears less effective as a single agent, though it may be a useful adjunct.
What is mifepristone?