Induction of labor in the nineties: Conquering the unfavorable cervix
. ObstetGynecol 1997; 90: 235-9.
Additionally, they noted that induction at 39 weeks should not be avoided with the goal of preventing CD, as even women with an unfavorable cervix
had a lower rate of CD in the induction group compared with the expectant management group.
Hence PGE2 gel can be recommended as a useful and potent method of induction of labor with unfavorable cervix
Prelabor rupture of membranes at term in patients with an unfavorable cervix
: active versus conservative management.
In April 2010, all 92 Dutch hospitals with an obstetric practice received a postal questionnaire concerning methods of cervical ripening in women with an unfavorable cervix
. One obstetrician per hospital was addressed and was asked to reply on behalf of the hospitals obstetric staff and based on protocols or policies.
It is certainly an option for the nulliparous woman or the multiparous patient with an unfavorable cervix
. The hospital setting would be a better choice with increasing parity and favorability of cervical assessment.
One randomized controlled trial reported that in women with an unfavorable cervix
at term, induction of labor with a Foley catheter is similar to induction of labor with prostaglandin E2 gel, with fewer maternal and neonatal side-effects19.
Nulliparous pregnant women with an unfavorable cervix
who were induced after 39 weeks' gestation were more likely to have a cesarean delivery than were women undergoing expectant management, but the ceserean rate was not doubled, according to a new study.
If your patient is now at 42 weeks' gestation with an unfavorable cervix
, and you are looking at an induction and the morbidity and risks of that, it may not be as reasonable to proceed with a trial of labor as with a patient who is in a spontaneous labor at 38 weeks.
Finally, the intravaginal route of gel administration may not be so effective as the intracervical route in cervical ripening and induction for an unfavorable cervix
.  The intracervical route may also offer advantages in less systemic absorption, although both altering the vehicle for vaginal drug administration and lowering the dose may further limit side effects without lowering efficacy.
Misoprostol compared with prostaglandin E2 for Labour induction in women at term with intact membranes and unfavorable cervix
: a systematic review.
At the same time, the hospital continues to get referrals for the management of placenta accreta from women who've had too many cesareans, reflecting the need to have the "bigger conversation" with patients about what they and the hospital can do to safely avoid the primary cesarean and interventions that increase cesarean risk, such as induction of labor with an unfavorable cervix
, he said.