Cervical ripening

Oxytocin Cervical Ripening 2-6 milliunits per minute intravenous infusion (high dose) 1-2 milliunits per minute intravenous infusion (low dose) ... 

Continuously monitor uterine activity and fetal heart rate when giving drug therapy for cervical ripening or oxytocin. Total duration of monitoring depends on the agent used, and current guidelines recommend the following44,45 ... 

Oxytocin is the most commonly used agent for labor induction after cervical ripening. 

Wing DA. A benefit-risk assessment of misoprostol for cervical ripening and labour induction. Drug Saf... 

PGE2 Vasodilation, decreased gastric acid secretion, pain sensitization, nterine contraction, cervical ripening, maintenance of patent dnctns arteriosns, bronchodilation, fever... 

Lfterine Delayed parturition, dystocia PGE2,PGF2 ,and other prostaglandins are involved cervical ripening, uterine contractions COX-2... 

Other physiological events must occur at the end of pregnancy to facilitate birth. The cervix begins to soften cervical ripening) as a direct result of connective tissue... 

Because dinoprostone produces cervical ripening along with stimulation of the uterus, it has been used as an alternative to oxytocin for the induction of labor. Preparations of dinoprostone can be placed in either the cervix or the posterior fornix. Prepidil is a formulation and delivery system of dinoprostone that delivers a dose of 0.5 mg into the cervix, while Cervidil consists of the drug embedded in a plastic matrix. The matrix is designed to deliver a dose of 0.3 mg per hour for 12 hours. 

Misoprostol (Cytotec) is a prostaglandin Ej analogue that is being evaluated as a cervical ripening agent. It also is used in the treatment and prevention of peptic ulcer disease (see Chapter 40). Clinical trials show that misoprostol is an effective agent for both cervical ripening and labor induction. It appears to be as effective as dinoprostone and is much less expensive. 

The effects of vaginal misoprostol for third trimester cervical ripening or induction of labor has been reviewed... 

Several cases of uterine rupture due to misoprostol after second trimester have been reported. However, unexpectedly, administration of misoprostol for cervical ripening before surgical evacuation of a missed abortion reportedly produced uterine rupture in the first trimester... 

Cervical laceration associated with misoprostol has been reported in a 33-year-old woman who received four doses of vaginal misoprostol (total dose 100 micrograms) for labor induction. Uterine rupture has occurred during induction of labor with misoprostol, usually in women who have had a previous cesarean section (22,23). Uterine dehiscence occurred in one and uterine rupture in three of 48 women with prior cesarean sections treated with intravaginal misoprostol 50 micrograms for cervical ripening (24). In comparison, uterine rupture occurred in one of 89 women who had an oxytocin infusion and none of 24 patients who received intravaginal alprostadil. 

Hofmeyr GJ, Gulmezoglu AM. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev 2003 (1) CD000941. 

Hill DA, Chez RA, Quinlan J, Fuentes A, LaCombe J. Uterine rupture and dehiscence associated with intravaginal misoprostol cervical ripening. J Reprod Med 2000 45(10) 823-6. 

---