What makes a cervix favorable for induction

With this scoring system, a number ranging from 0—13 is given to rate the condition of the cervix. A Bishop score of less than 6 means that your cervix may not be ready for labor. Ripening the cervix is a process that helps the cervix soften and thin out in preparation for labor.

Medications or devices may be used to soften the cervix so it will stretch dilate for labor. Ripening of the cervix can be done with prostaglandins or with special devices. Prostaglandins are drugs that can be used to ripen the cervix. They are forms of chemicals produced naturally by the body. These drugs can be inserted into the vagina or taken by mouth.

Some of these drugs are not used in women who have had a previous cesarean delivery or other uterine surgery to avoid increasing the possible risk of uterine rupture tearing. Laminaria a substance that absorbs water can be inserted to expand the cervix. A catheter small tube with an inflatable balloon on the end also can be inserted to widen the cervix. Stripping the membranes is a way to induce labor.

The health care professional sweeps a gloved finger over the thin membranes that connect the amniotic sac to the wall of your uterus. This action may cause your body to release prostaglandins, which soften the cervix and may cause contractions. Rupturing the amniotic sac can start contractions. It also can make them stronger if they have already begun. Lauren M. Wheeler, M. Joel M. Bernstien, M. Bari Byrd, M. Alison Kalinowski, M.

John Yoon, M. Erica K. Two Locations. Balloon devices provide mechanical pressure directly on the cervix as the balloon is filled. A Foley catheter 26 Fr or specifically designed balloon devices can be used. The technique is described in Table 3. 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.

Additional steps that may be taken: Apply pressure by adding weights to the catheter end. Constant pressure: attach 1 L of intravenous fluids to the catheter end and suspend it from the end of the bed. Saline infusion 12 : Inflate catheter with 40 mL of sterile water or saline. Remove six hours later or at the time of spontaneous expulsion or rupture of membranes whichever occurs first. Information from references 7 , and 12 through Currently, several RCTs are comparing use of a balloon device with administration of an extra-amniotic saline infusion, laminaria, or prostaglandin E 2 PGE 2.

Results from these trials indicate that each of these methods is effective for cervical ripening and each has comparable cesarean-section delivery rates in women with an unfavorable cervix. The membranes are stripped by inserting the examining finger through the internal cervical os and moving it in a circular direction to detach the inferior pole of the membranes from the lower uterine segment. The Cochrane reviewers concluded that stripping of the membranes alone does not seem to produce clinically important benefits, but when used as an adjunct does seem to be associated with a lower mean dose of oxytocin needed and an increased rate of normal vaginal deliveries.

It is hypothesized that amniotomy increases the production of, or causes a release of, prostaglandins locally. Risks associated with this procedure include umbilical cord prolapse or compression, maternal or neonatal infection, FHR deceleration, bleeding from placenta previa or low-lying placenta, and possible fetal injury.

The technique for performing amniotomy is described in Table 4. A pelvic examination is performed to evaluate the cervix and station of the presenting part. A cervical hook is inserted through the cervical os by sliding it along the hand and fingers hook side toward the hand.

The nature of the amniotic fluid is recorded clear, bloody, thick or thin, meconium. Information from references 7 and Only two well-controlled trials studied the use of amniotomy alone, and the evidence did not support its use for induction of labor.

Prostaglandins act on the cervix to enable ripening by a number of different mechanisms. They alter the extracellular ground substance of the cervix, and PGE 2 increases the activity of collagenase in the cervix. They cause an increase in elastase, glycosaminoglycan, dermatan sulfate, and hyaluronic acid levels in the cervix. A relaxation of cervical smooth muscle facilitates dilation. Finally, prostaglandins allow for an increase in intracellular calcium levels, causing contraction of myometrial muscle.

Currently, two prostaglandin analogs are available for the purpose of cervical ripening, dinoprostone gel Prepidil and dinoprostone inserts Cervidil.

Prepidil contains 0. The techniques for gel and pessary placement are described in Tables 5 and 6 , respectively. Patient is afebrile. No active vaginal bleeding is present. Fetal heart rate tracing is reassuring. Patient gives informed consent. Bring gel to room temperature before application, per manufacturer's instructions. Monitor fetal heart rate and uterine activity continuously starting 15 to 30 minutes before gel introduction and continuing for 30 to minutes after gel insertion. If the cervix is uneffaced, use the mm endocervical catheter to introduce the gel into the endocervix just below the level of the internal os.

If the cervix is 50 percent effaced, use the mm endocervical catheter. After application of the gel, the patient should remain recumbent for 30 minutes before being allowed to ambulate. End points for ripening include strong uterine contractions, a Bishop score of 8, or a change in maternal or fetal status. Do not start oxytocin for six to 12 hours after placement of the last dose, to allow for spontaneous onset of labor and protect the uterus from overstimulation.

Information from Hadi H. Cervical ripening and labor induction: clinical guidelines. Clin Obstet Gynecol ;— Patient selection see Table 5. Using a small amount of water-miscible lubricant, place the tab into the posterior fornix of the cervix.

As the device absorbs moisture and swells, it releases dinoprostone at a rate of 0. Monitor fetal heart rate and uterine activity continuously, starting 15 to 30 minutes before introduction of the insert. Because hyperstimulation may occur up to nine and one-half hours after placement of the insert, fetal heart rate and uterine activity should be monitored from placement of the insert until 15 minutes after it is removed.

Remove the insert by pulling the cord after 12 hours, when active labor begins, or if uterine hyperstimulation occurs. The Cochrane reviewers examined 52 well-designed studies using prostaglandins for cervical ripening or labor induction. Compared with placebo or no treatment , use of vaginal prostaglandins increased the likelihood that a vaginal delivery would occur within 24 hours.

In addition, the cesarean section rate was comparable in all studies. The only drawback appears to be an increased rate of uterine hyperstimulation and accompanying FHR changes. Misoprostol Cytotec is a synthetic PGE 1 analog that has been found to be a safe and inexpensive agent for cervical ripening, although it is not labeled by the U. Food and Drug Administration for that purpose.

Clinical trials indicate that the optimal dose and dosing interval is 25 mcg intravaginally every four to six hours. Risks also include tachysystole, defined as six or more uterine contractions in 10 minutes for two consecutive minute periods, and hypersystole, a single contraction of at least two minutes' duration.

Finally, uterine rupture in women with previous cesarean section is also a possible complication, limiting its use to women who do not have a uterine scar.

Place one fourth of a tablet of misoprostol intravaginally, without the use of any gel gel may prevent the tablet from dissolving. Monitor fetal heart rate and uterine activity continuously for at least three hours after misoprostol application before the patient is allowed to ambulate.

When oxytocin Pitocin augmentation is required, a minimum interval of three hours is recommended after the last misoprostol dose.

If your cervix is ready for labor, your healthcare provider may offer to rupture your membranes. This involves using a small hooked instrument to break your amniotic sac. There is an increased risk of infection, placental abruption , and umbilical prolapse. It involves giving you synthetic oxytocin through an IV pump. Oxytocin is the natural hormone that your body produces during labor to stimulate contractions. In most cases, women may need between 6 and 12 hours on a Pitocin drip to enter active labor.

Usually, the drip will be started on the lowest dose and increased gradually until your contractions become regular. Contractions on a Pitocin drip are usually stronger and more painful than they would be naturally. There is no gentle build up to the contraction peak like you would get in a labor that started spontaneously. Instead, these contractions hit hard right at the beginning. These interventions include:. Your healthcare provider will only suggest induction if they believe waiting for labor to start would be riskier than intervening.

Stress is a known inhibitor of oxytocin release. If you want your labor to start naturally, one of the best things you can do is to fully relax.

Pamper yourself, avoid known stressors, and allow your hormones to flow. Exercise may help get your baby into the optimum position for labor, which will allow them to put the desired pressure on your cervix. Staying active and maintaining a healthy diet throughout your pregnancy are great ways to avoid developing gestational diabetes, which is a known risk factor in the induction of labor. Your Bishop score can help you and your healthcare provider understand your labor progression.

Your score may also be used to help determine whether you are a good candidate for labor induction. Your healthcare provider should be able to provide you with all the evidence you need to weigh the risks and benefits and make an informed decision about what is right for you and your baby.

Your baby dropping is one of the first signs that your body is getting ready for labor.