Question 5

A 37 yo G2P1 presents for IOL at 41 weeks gestation. Her pregnancy has been uncomplicated. Fetal monitoring is category I. She has mild contractions and rupture membranes 12 hours ago. She presently has 4 contractions every 10 minutes. Two days ago, her cervix was closed/30/-2/posterior/medium consistency, and those findings were unchanged on initial presentation. What is the next best step in treatment?

Answer Choices:

Expectant management

Oxytocin infusion

Vaginal misoprostol

Transcervical balloon placement

Correct Answer:

Oxytocin infusion

Explanation:

  • IOL in the setting of PROM (premature rupture of membranes) decreases time to delivery and rates of chorioamnionitis, endometritis and admission to the NICU without increasing cesarean delivery of operative vaginal delivery

  • Generally, an unfavorable cervix is defined by Bishop score of 6 or less

  • With a Bishop score of 8 or greater, the probability of vaginal delivery with IOL equals that of spontaneous labor

  • Often, patients with an unfavorable cervix can benefit from cervical ripening to facilitate softening and dilation of the cervix

  • Oxytocin is preferred for induction and augmentation of labor with PROM as it has been associated with similar effectiveness but lower rates of chorioamnionitis compared to vaginal prostaglandins