Cervical ripening.

When induction of labour is being considered the first step should be to assess the cervical score. If this is low, the gestational age should be confirmed since an unripe cervix is normal in earlier pregnancy and there may be a mistake in the patient's dates. If the maturity is confirmed, the choice lies between delivering the baby and waiting. Few genuine indications for induction change by waiting and increased risks may occur by postponing the date of delivery. The choice may then lie between elective caesarean section or amniotomy and intravenous oxytocin with an unripe cervix on the one hand, and cervical ripening before induction of labour on the other (Lancet, 1979). The last course has many advantages to commend it. There is still much to be learnt about cervical ripening. The success of the prostaglandins suggests that they may be the agents of choice at present. The ideal preparation would be one that could be administered vaginally to ripen the cervix without inducing uterine contractions. A major problem to date has been the absence of a commercially available PGE2 preparation for local use and this has necessitated the formulation of home-made gels and pessaries by individual hospital pharmacies. However, recently Prostin E2 vaginal tablets (each containing dinoprostone 3 mg) have been marketed and initial studies (Stewart et al, 1983) have shown promising results.