Current trends in cervical ripening and labor induction.

Labor is induced in more than 13 percent of deliveries in the United States. Postdate pregnancy is the most common indication. Oxytocin is the drug of choice for labor induction when the cervical examination shows that the cervix is favorable. The use of this agent requires experience and vigilant observation for uterine hyperstimulation, hypertonus or maternal fluid overload. In a patient whose cervix is unfavorable, the use of prostaglandin analogs for cervical ripening markedly enhances the success of inductions. Misoprostol, a prostaglandin E1 analog marketed as a gastrointestinal mucosal protective agent, is safe, efficacious and inexpensive for use in cervical ripening and labor induction. Further studies will better delineate its optimal use. Family physicians need to be familiar with the various methods of cervical ripening and labor induction.