07/28/2026
In July of 2025, the American College of Obstetricians & Gynecologists - ACOG published a Clinical Practice Guideline (number 9) titled, Cervical Ripening in Pregnancy.
The objective was to review methods of cervical ripening and to summarize the efficacy and safety of the current available methods.
💡 A few key takeaways that I wanted to point out:
➡️ Due to the risk of uterine rupture, misoprostol (Cytotec) and other prostaglandin preparations are contraindicated in patients with a history of uterine surgery, including cesarean delivery
➡️ Pharmacologic (i.e. Cytotec Cervidil), mechanical (single foley balloon catheter), or combination methods are appropriate
↪️ Combination methods are recommended to shorten the time from admission to delivery in appropriate candidates
➡️ Vaginal compared with oral misoprostol (Cytotec) reduced the need for oxytocin use before delivery
➡️ The use of either oral or vaginal misoprostol (Cytotec) is recommended
↪️ Vaginal: more effective
↪️ Oral results in:
↪️ fewer vaginal births within 24 hours
↪️ longer time from induction to vaginal birth
↪️ less tachysystole with fetal heart rate changes
➡️ no difference in overall cesarean delivery rates
↪️ cesarean delivery rate for fetal distress is lower with oral misoprostol (Cytotec)
➡️ Neonatal outcomes overall do not differ between oral and vaginal administration, including 5-minute Apgar score lower than 4, umbilical cord blood pH less than 7.0, meconium aspiration syndrome, birth asphyxia, neonatal encephalopathy or seizures, sepsis, and perinatal death
➡️ Sublingual or buccal administration is associated with an increased risk of uterine tachysystole. IS NOT RECOMMENDED FOR ROUTINE USE IN CERVICAL RIPENING 🚫
COMMENT AND SHARE ‼️
Have you observed a clinical practice change since this publication? In your reviews and/or experiences, what route of Cytotec administration do you identify to be the most common?
Cervical Ripening in Pregnancy: ACOG Clinical Practice Guideline No. 9: (2025). Obstetrics & Gynecology, 146(1), 148–160.
PURPOSE:The purpose of this document is to review current methods for cervical ripening and to summarize the effectiveness of these approaches based...
