Dr. Chapa’s Clinical Pearls. New Guidance on OB CX Ripening (July 2025)
Jun 21, 2025
Discover the updated ACOG guidelines on cervical ripening that are set to transform labor induction practices. Explore the exciting recognition of combination mechanical and pharmacologic methods. Get insights into outpatient cervical ripening and the latest protocols for using oral and vaginal prostaglandins. This discussion is essential for healthcare professionals looking to enhance their induction strategies and improve patient outcomes.
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Bishop Score Limitation
- The Bishop score is relevant only for term pregnancies with intact membranes.
- In cases of ruptured membranes, labor induction can proceed without using the Bishop score.
Combination Therapy Endorsed Conditionally
- ACOG recommends pharmacologic, mechanical, or combination cervical ripening methods.
- Combination therapy is suggested conditionally, requiring shared decision-making with patients.
Recommended Prostaglandin Dosages
- Use oral misoprostol at 20-25 micrograms every 2 hours or 50-100 micrograms every 4 hours.
- Use vaginal misoprostol at 25 micrograms every 3-6 hours; avoid buccal and sublingual routes due to risks.