Cervical Ripening and Induction of Labor

Wheeler, Vernon MD
Hoffman, Ariel MD
Bybel, Michael DO

¹ Carl R. Darnall Army Medical Center, Fort Hood, Texas; Uniformed Services University of the Health Sciences, Bethesda, Maryland; Texas A&M Health Science Center College of Medicine, Temple, Texas
² Martin Army Community Hospital, Fort Benning, Georgia; Uniformed Services University of the Health Sciences, Bethesda, Maryland
³ Carl R. Darnall Army Medical Center, Fort Hood, Texas; Uniformed Services University of the Health Sciences, Bethesda, Maryland

VERNON WHEELER, MD, FAAFP, is the research director and a family medicine and obstetrics faculty member at Carl R. Darnall Army Medical Center, Ford Hood, Tex.; an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md.; and a clinical assistant professor at Texas A&M Health Science Center College of Medicine, Temple.

ARIEL HOFFMAN, MD, is a faculty member in the Family Medicine Residency Program at Martin Army Community Hospital, Fort Benning, Ga., and an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences.

MICHAEL BYBEL, DO, FAAFP, is the associate program director at Carl R. Darnall Army Medical Center and an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences.

The Authors

Address correspondence to Vernon Wheeler, MD, FAAFP, Carl R. Darnall Army Medical Center Family Medicine Residency, 36065 Santa Fe Ave., Fort Hood, TX 76544 (email:[email protected]). Reprints are not available from the authors.

Author disclosure: No relevant financial relationships.

This is a corrected version of the article that appeared in print.

American Family Physician 105(2):p 177-186, February 2022.

Induction of labor is a common obstetric procedure, and approximately one-fourth of pregnant patients undergo the procedure. Although exercise and nipple stimulation can increase the likelihood of spontaneous labor, sexual intercourse may not be effective. Acupuncture has been used for labor induction; however, it has not been shown to increase vaginal delivery rates. There is strong evidence that membrane sweeping can increase the likelihood of spontaneous labor within 48 hours. Cervical preparation or ripening is often needed before induction. Some evidence shows that the use of nonpharmacologic approaches such as osmotic dilators and cervical ripening balloons reduce time to delivery. The effect of amniotomy on labor is uncertain. Pharmacologic intervention with oxytocin or prostaglandins is effective for cervical ripening and induction of labor. Combining a balloon catheter with misoprostol is a common practice and has been shown to decrease time to delivery in a small study.

This article updates clinical guidelines for induction of labor, including indications, assessment of cervical favorability, and timing of induction. The authors review the effectiveness and safety of inducing labor using mechanical and pharmacologic methods and their combination.