Cervical ripening is a process of childbirth in which the cervix softens and dilates in preparation of labor. 

The cervix is the lower part of the uterus that allow the passage for the baby during labor. 

Prostaglandins is main hormones for cervical ripening, as they break down collagen fibers for labor. 

Relaxin hormone indicated to relax the cervix and the pelvic ligaments. Estrogen level towards the end of pregnancy is used to enhance the production of prostaglandins. 

Cervix made of collagen, proteoglycans, and smooth muscle. Ripening breaks collagen and adds water to increase the flexibility. 

Hormones involved in cervical ripening are: 

• Prostaglandin 
• Relaxin 
• Estrogen 
• Oxytocin 

Cervical ripening correlates with labor induction rates with globally estimated at 10% to 30% of pregnancies. 

High-income countries have higher labor induction rates due to proactive pregnancy management and advanced age. 

Cervical ripening is a natural process in many pregnancies. It is seen in first pregnancy and overdue pregnancies. 

Older pregnant women may need labor induction and cervical ripening due to age. 

Matrix metalloproteinases reduce cervix tensile strength to break collagen fibers. 

Proteoglycans attract water molecules to increase the hydration of the cervical tissue. This hydration helps to lose the collagen matrix. 

The concentration of glycosaminoglycans is changed during ripening to soften the cervix. 

The breakdown of collagen in the extracellular matrix reduces the firmness of the cervix.  

Causes of cervical ripening are: 

• Hormonal Factors 
• Biochemical Factors 
• Cervical Insufficiency 
• Delayed or Inadequate ripening 
• Maternal Factors 
• Genetic and Hereditary Factors 

Bishop Score evaluates cervix for labor readiness based on dilation, effacement, consistency, position, and fetal head station. 

Increased Bishop Score indicates favourable cervix and predicts higher chance of spontaneous labor or induction success. 

Successful vaginal deliveries related to easier cervical ripening and lower cesarean section rates. 

Elderly mothers have higher chance of induction and C-section due to slow cervical ripening. 

Shorter cervix at end of pregnancy is connected to advanced ripening and increased spontaneous labor. 

Detailed information including obstetric, gynecological and medical history of patient should be gathered. 

• Digital cervical examination 
• Bishop score assessment 
• Transvaginal Ultrasound assessment 

Symptoms are: 

Increased pelvic pressure, change in vaginal discharge, regular contractions, and lower back pain 

The treatment for cervical ripening involves preparing the cervix for labor that induces labor due to medical or obstetric indications.  

Prostaglandins facilitate cervical changes through collagen breakdown and increased blood flow. 

Oxytocin is used for labor induction rather than cervical ripening, but it helps in labor once the cervix has started to ripen. 

Mechanical methods include use of balloon catheter and hygroscopic dilators. 

Dinoprostone is available in the vaginal insert or gel form. Misoprostol is administered through oral or vaginal form.  

During a vaginal examination, the physician inserts a finger into the cervix and sweeps the membranes away from the lower uterine segment. 

Nipple stimulation is conducted to release endogenous oxytocin that increases uterine contractions. 

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Women undergoing outpatient cervical ripening for them create a calm, safe, and comfortable home environment. 

Encourage gentle physical activity to keep fetal head and exert pressure on the cervix. 

Positioning promotes optimal fetal position to facilitate cervical ripening and labor. 

Proper awareness about cervical ripening should be provided and its related causes with management strategies. 

Appointments with a gynaecologist and preventing recurrence of disorder is an ongoing life-long effort. 

OB/GYN and Women\'s Health

Dinoprostone: 

It relaxes cervical smooth muscle to stimulate uterine contractions. 

Misoprostol: 

It inhibits prostaglandin synthesis to gastric acid secretion and protects gastric mucosa. 

OB/GYN and Women\'s Health

Oxytocin: 

It activates G-protein-coupled receptors that trigger increases in intracellular calcium levels in uterine myofibrils 

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A foley catheter with a balloon is inserted through the cervical canal. 

Laminaria dilators are small cylindrical rods made from natural that are inserted into the cervical canal. 

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In the initial assessment phase, evaluation of medical history, physical examination and diagnostic test to confirm diagnosis. 

Pharmacologic therapy is effective in the treatment phase as it includes use of prostaglandins and oxytocic agents. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies. 

The regular follow-up visits with the gynecologist are scheduled to check the improvement of patients along with treatment response.