Cervical Ripening

This lecture available at Cervical Ripening.ppt

Points of clarification, all data from Cochrane Reviews unless otherwise cited:

Castor oil, there no good data for induction of labor with Castor oil
Sweeping of Membranes and stripping of membranes is the same
Like most types of cervical ripening, patients are admitted for ripening with Foley catheter
In patients without contraindications misoprostol is more effective and less costly than cervidil or Prepidil
Sexual intercourse has NOT been shown to contribute to preterm labor in low risk pregnancies
Nipple Stimulation has NOT been studied in HIGH risk patients
Indications for pre40 week induction include pre-eclampsia, PROM, IUGR, etc., the best evidence regarding outcomes is with PROM
One study used "synchronous" administration of Foley Catheter and pitocin and found reduced time required for cervical change and speculated on this contributing to infection reduction. IJOGVolume 82, Issue 1, July 2003, Pages 71-72

Transcervical Foley Catheter for Labor Induction method involves a 22 or 26-F Foley catheter with a 30-50 mL balloon is introduced past the internal cervical os into the lower uterine segment, but outside the chorioamnion. The balloon is inflated with normal saline, pulled back against the internal os until snug, and the Foley was taped to the inside of the maternal thigh under minimal tension.Obstetrics & Gynecology: Volume 110(3), September 2007, pp 558-565 or The catheter is introduced into the endocervix by direct visualization or blindly by locating the cervix with the examining fingers and guiding the catheter over the hand and fingers through the endocervix and into the potential space between the amniotic membrane and the lower uterine segment. The balloon reservoir is inflated with 30 to 50 mL of normal saline. The balloon is retracted so that it rests on the internal os. Am Fam Physician. 2003 May 15;67(10):2123-8

However uncommon, a systematic review, concluded that the use of mechanical methods of cervical ripening, in fact, does increase maternal infection and neonatal infection AJOG Volume 199, Issue 2, August 2008, Pages 177-188

No TrackBacks