[Cervical ripening in late pregnancy and at term]

Cervical ripening before labors is not an exclusively passive process by uterine contractions. On the contrary, we can find a lot of highly active processes in the cervical connective tissue with changes in metabolism of the cells leading to changes in the ground substance and the organisation and structure of collagenous fibres. We do not as yet know the trigger mechanisms of the prepartum cervical rpiening. Probably prostaglandins and relaxin are such triggering substances. At present, our new understanding of this active cervical process does not help the obstetrician. There is no laboratory test up to now. Cervical ripeness can only be examined on the basis of clinical criteria: length, consistency, position, and dilatation of the cervix uteri and station of the fetal head. The most usual score of cervical ripeness is Bishop's Pelvic-score. A high scoring excludes failures of induction of labor. But the rate of wrong prognosis, concerning efficiency of induction and time of labor is relatively high in cases with low rating of cervical ripeness. A more differentiated scoring of some of the criteria and some weighing of these seems to lead to better prognosis. On the other hand, recent clinical experiences with prostaglandins lead us to expect that we will be able to induce cervical ripeness.