The unfavorable cervix: methods of cervical priming

Given the widespread interest in cervical ripening techniques, and the fact that prolonged pregnancy is a most common potential indication, it is disappointing to have encountered so few clinical trials addressing this specific clinical challenge. We await further studies to define the ultimate roles for relaxin and synthetic laminaria. Whether the addition of oral tocolytics to PGE2 will overcome the uterine hyperstimulation complications without reducing its effectiveness remains unanswered. For the present, however, only PGE2 has been clearly shown to improve perinatal outcome in prolonged pregnancy, and its use is an alternative to antepartum surveillance when the cervical status is unfavorable. One final word of caution would seem prudent at this time. Informed consent should be strongly considered prior to employing any of the cervical priming techniques described. Involving the patient in this process should improve communication and understanding between doctor and patient, which ultimately leads to better care.