In a normal pregnancy with an unfavorable cervix, which intervention is used to promote cervical ripening?

• A. Elective cesarean section
• B. Vacuum-assisted delivery
• C. Expectant management only
• D. Induction with prostaglandin gel

Answer: (D)

When the cervix is unfavorable, the goal is to prepare it for labor by making it softer, more dilated, and more pliable so induction can progress. Prostaglandins, such as dinoprostone gel, are used to accomplish this cervical ripening. They act on the cervical tissue to remodel collagen, increase water content, soften the cervix, and promote dilation, which raises the Bishop score and enables a more effective induction or onset of labor.

Elective cesarean section would bypass the vaginal labor process and isn’t used to promote ripening. Vacuum-assisted delivery is a second-stage intervention after labor has progressed. Expectant management alone delays necessary preparation. Induction with prostaglandin gel directly targets ripening, making it the best choice in this scenario.