Cervical ripening - A review and recommendations for clinical practice

Cervical ripening occurs before the onset of labor. The cervix is metabolic ally active during ripening and passive during active labor. A ripe cervix indicates readiness for labor and predicts successful induction of labor. P ractitioners evaluate cervical readiness for labor using the Bishop score. Membrane stripping, mechanical dilators and prostaglandins are ripening met hods used frequently because they are simple, effective, efficient, safe an d well tolerated. Stripping of membranes, a Foley catheter and misoprostol tablets are less expensive than other available methods. Because prostaglan dins may cause excessive myometrial activity and even labor, hospitalizatio n and fetal monitoring are recommended. Despite their effectiveness, these methods often do not decrease the cesarean section rates. This finding may be explained by the fact that each study reviewed only included a small num ber of patients and that in most cases, amniotomy was done and induction st arted, when feasible, before the women reached a Bishop score greater than or equal to 9. Larger studies may have different outcomes. The type of ripe ning methods used depends on the urgency of the situation; balloon catheter s and prostglandins often act within 12 hours, while membrane stripping is less predictable.