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Cervical Ripening - Benefits, Risks, and Methods

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During the cervical ripening process, the cervix prepares for labor. This article will explain cervical ripening and its different methods in detail.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Richa Agarwal

Published At November 21, 2022
Reviewed AtNovember 29, 2022

What Is Cervical Ripening?

The cervix is closed during pregnancy to keep the baby inside the uterus, but when the labor starts, the cervix will open widely to let the baby come out through the cervix. So the cervix changing from firm and close to soft and thin is called cervical ripening. Cervical ripening is the initial process to help the cervix dilate and thin out. It commonly happens naturally on its own during labor. But in some women, assisted cervical ripening may be needed. This may be done through devices, medicines, or procedures to ripen the cervix.

Who May Require Cervical Ripening?

Cervical ripening is helpful for people who have induced labor. Labor induction can be done with any procedures or medicines to initiate contractions and start labor. Cervical ripening or induction of labor is necessary for the following situations:

What Are the Benefits of the Cervical Ripening Procedure?

Cervical ripening is optional and, it is not necessary to undergo this procedure before labor induction. There are many benefits to having cervical ripening, and it helps to start natural labor or shorten the labor process. In a few women, labor occurs after cervical ripening without an induction medication. Cervical ripening also helps labor-inducing medications, like oxytocin, be more successful.

What Is the Risk Associated With Cervical Ripening Procedures?

There are different cervical ripening methods, and each method has its own set of risks. The risks associated with cervical ripening include:

  • The medication taken for cervical ripening might cause fever, diarrhea, nausea, vomiting, and too many contractions (hyperstimulation).

  • Uterine hyperstimulation is rare but can cause serious side effects due to some labor-inducing medications. They can cause too frequent or prolonged contractions, which can be life-threatening to the fetus.

  • Sometimes fetal distress may occur after taking medications, requiring an emergency C-section.

  • If cervical ripening procedures are done, then bleeding, fetal injury, drop in fetal heart rate, infection of the mother and fetus, umbilical cord prolapse (the cord drops into the cervix), umbilical cord compression (the cord gets compressed and does not supply enough blood to the fetus) or even death of the fetus can occur.

When Do the Health Care Professionals Decide to Go With Cervical Ripening?

The doctors use the Bishop score to check the degree of cervical ripening. The doctor notes the Bishop's score while examining the cervix, which can range from 0 to 13. They also check if the cervix is thinning, softening, or dilating. The cervix is not very ripe if the Bishop's score is less than six. So, cervical ripening may be necessary. And if the Bishop score of more than eight indicates that the body is getting prepared for labor, cervical ripening is not required in such cases.

What Are the Methods of Cervical Ripening?

There are different methods used in cervical ripening, including:

1) Non-pharmacological Cervical Ripening -

  • Herbal Supplements - Evening primrose oil, black and blue cohosh, red raspberry leaves, and black haw are commonly prescribed herbal supplements for cervical ripening. The risks and benefits of these herbal agents are still unclear because the evidence is based on traditional long-term use by a certain population.
  • Sexual Intercourse - Sexual intercourse is also recommended for triggering labor initiation. During sexual activity, oxytocin is released, and the lower uterine is stimulated during penetration, which releases prostaglandins that help promote labor.

  • Castor Oil, Enema, and Hot bath - Castor oil, enemas, and a hot bath are also recommended for labor induction and cervical ripening. The mechanisms of action for castor oil, hot bath, and enema are unknown.

  • Breast Stimulation - Breast massage and nipple stimulation release oxytocin from the pituitary gland that helps to induce labor. The most commonly recommended technique is applying warm compresses to the breasts or gently massaging the breasts three times a day for one hour.

  • Acupuncture - involves using fine needles in selected locations to prevent or cure disease. These days acupuncture and transcutaneous nerve stimulation (TENS) are used to stimulate the release of oxytocin and prostaglandins.

2) Pharmacological - Cervical softening medications are used to help in the dilation and effacement of the cervix. These drugs can be administered orally, intravenously (IV), or vaginally. The commonly used medications are:

  • Prostaglandins.

  • Oxytocin.

  • Relaxin.

  • Estrogen.

  • Progesterone receptor antagonists.

  • Hyaluronic acid.

The medications' common side effects are hyperstimulation of the uterus, uterine rupture, and passage of stool by the fetus. These drugs are contraindicated in mothers with a history of c-sections.

3) Mechanical Methods - In this method, some form of local pressure is applied to trigger the release of prostaglandins. This method has a high risk of bleeding, infection, membrane rupture, and placental disruption.

  • Hygroscopic Dilators - The vagina and surrounding area are cleaned with an antiseptic solution before the procedure. A speculum is used to dilate and visualize the cervix, and the dilators are introduced. The dilators are placed till the cervix is fully dilated.

  • Balloon Dilators - They provide mechanical pressure on the cervix as the balloon is filled and inflated. A catheter is introduced into the cervix then the balloon is inflated with 30 to 50 ml of saline. It is placed in the internal os till the rupture of the cervix.

4) Surgical Method -

  • Stripping of the Membrane - Stripping of the membranes can cause an increase in the activity of prostaglandin and phospholipase by mechanical dilation of the cervix, which will release prostaglandins. The stripping of the membranes is done by inserting a gloved finger through the vagina and moving it in a circular movement to detach the membranes from the lower uterine segment. Infection, accidental rupture of the membranes, bleeding, and patient discomfort are the side effects of this method.

  • Amniotomy - A small hook is used to rupture the membranes around the fetal head. By breaking the sac, there is the release of prostaglandins that enable cervical ripening. The side effects of this procedure include maternal or neonatal infection, umbilical cord compression or prolapse, bleeding from placenta previa or low-lying placenta, reduction in fetal heart rate, and possible fetal injury.

Conclusion -

Cervical ripening happens naturally during labor. However, in some women, it is performed to induce labor. There are different methods for cervical ripening, and each method has associated risks. The health care professionals choose a method depending on the health and condition of the pregnant women.

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Dr. Richa Agarwal
Dr. Richa Agarwal

Obstetrics and Gynecology

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