The patient has still not gone into spontaneous labor at 41 weeks’ gestation. You see her in clinic and her blood pressure is 150/90 mmHg and she has +3 proteinuria on urine dipstick. You send her to labor and delivery for further evaluation, and her blood pressure remains elevated, consistent with a diagnosis of preeclampsia. You examine her cervix and find that it is closed and thick. She asks whether she can undergo induction of labor at this point.
What should you tell her about induction of labor?A. She may be induced after using a prostaglandin as a cervical ripening agent
Induction of labor for maternal or fetal indications is an option for women undergoing TOLAC. However, the chance of successful TOLAC with induction versus spontaneous labor is lower, and her unfavorable cervical examination decreases the potential success rate. Data support use of mechanical ripening agents, such as transcervical catheter, in this setting of an unfavorable cervix. Prostaglandins are not used for cervical ripening due to concerns over increased risk of uterine rupture.