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Cervical Ripening
Aka: Cervical Ripening
- See Also
- Membrane Stripping (C0404329)
- Cervical Membrane Sweeping
- Medications: Standard
- Dinoprostone (PGE2 Gel, Cervidil, Prepidil)
- Misoprostol (PGE1, Cytotec)
- Procedures: Methods to apply pressure to endocervix
- General
- Mechanism: Local pressure releases prostaglandins
- Risks
- Infection risk with Laminaria
- Artificial Rupture of Membranes
- Abruptio Placenta
- Cervical or uterine bleeding
- Hygroscopic Dilator (Laminaria, Lamicel)
- Dilator swells with absorption of local fluid
- Preparations
- Laminaria japonicum (Kelp, natural)
- Lamicel (synthetic)
- Technique
- Outpatient placement of dilator in endocervix
- Successive dilators placed until endocervix full
- No Fetal Heart Rate monitoring needed
- Balloon Dilator (e.g. 16 french Foley Catheter)
- Technique
- Catheter placed in endocervix
- Catheter tip inflated with 30 cc sterile water
- Traction applied to catheter
- Start Induction when catheter is extruded
- Adjuncts
- Weight end of catheter
- Tug on catheter 2-4 times per hour
- Sterile saline infusion
- Prostaglandin Gel
- Safety
- Does not appear to predispose to subsequent PTL
- Sciscione (2003) Am J Obstet Gynecol 190:751-4 [PubMed]
- Non-Pharmacologic Methods
- Breast stimulation
- See Oxytocin Challenge Test
- Rigorous trials lacking to show benefit
- Theoretical benefit
- Breast stimulation stimulates Oxytocin release
- Fetal Heart Rate response similar to OCT
- Technique
- Gentle massage or warm compresses applied to Breast
- Done for one hour or repeated three times daily
- Sexual Intercourse
- Benefits in Cervical Ripening or induction unclear
- Theoretical benefit
- Female orgasm induces uterine contraction
- Semen contain prostaglandins
- Acupuncture or TENS unit
- Proposed for Oxytocin and prostaglandin release
- No rigorous studies to show benefit
- Protocols: Alternative/Herbals
- General
- Used by some nurse-midwives in United States
- Anecdotal use in some cultures as long tradition
- No current rigorous studies on safety and efficacy
- Herbals historically used for Cervical Ripening
- Evening Primrose Oil
- Black Haw
- Black Cohosh
- Blue Cohosh
- Red raspberry leaves
- References
- McFarlin (1999) J Nurse Midwifery 44:205-16 [PubMed]
- Protocols: Disproved Methods that are not recommended
- Castor oil
- Hot baths
- Enemas
- References
- Adair (2000) Clin Obstet Gynecol 43:447-54 [PubMed]
- Tenore (2003) Am Fam Physician 67(10):2123-8 [PubMed]