## Indications for Cervical Ripening Before Induction of Labor **Key Point:** Cervical ripening is indicated when induction of labor is planned and the cervix is unfavorable (Bishop score ≤6). However, certain clinical situations are **contraindications** to induction and cervical ripening altogether — most notably, a **previous classical (vertical) uterine incision**. ### Why Option B is the Correct "NOT" Answer A **previous cesarean section with a classical (vertical) uterine incision** is a **contraindication** to labor induction and cervical ripening — NOT an indication. Classical uterine incisions carry a uterine rupture risk of 4–9% with labor, compared to <1% for low transverse incisions. Therefore, these patients are delivered by elective repeat cesarean section, and cervical ripening agents (prostaglandins, mechanical dilators, oxytocin) are contraindicated. > **Reference:** Williams Obstetrics, 25th edition — Classical uterine incision is listed as an absolute contraindication to trial of labor after cesarean (TOLAC) and to any form of cervical ripening or labor induction. ### Recognized Indications for Cervical Ripening | Indication | Rationale | |---|---| | Unfavorable cervix in nulliparous women (Option A) | Nulliparity predicts failed induction; ripening improves vaginal delivery success | | Maternal age >35 years with unfavorable cervix (Option C) | Age-related reduced cervical compliance; ripening reduces cesarean risk | | Polyhydramnios with unfavorable cervix (Option D) | When induction is indicated (e.g., cord prolapse risk), an unfavorable cervix warrants ripening | **High-Yield:** The distinction is critical — a **previous low transverse cesarean** may be a candidate for TOLAC with careful ripening, but a **classical incision** is an absolute contraindication to any trial of labor or cervical ripening. **Clinical Pearl:** Always distinguish between: - **Contraindication to induction/ripening** (e.g., classical uterine scar, placenta previa, vasa previa, active herpes) — these patients should NOT undergo ripening. - **Indication for ripening** — induction is planned AND cervix is unfavorable. **Warning:** Do not confuse "previous cesarean with low transverse incision" (may be eligible for TOLAC) with "previous cesarean with classical incision" (absolute contraindication to labor). Option B describes the latter — making it NOT an indication for cervical ripening.
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.