MCN: The American Journal of Maternal/Child NursingNew Clinical Practice Guideline from the American College of Obstetricians and Gynecologists: Cervical Ripening in Pregnancy

ACOG’s 2025 guideline establishes evidence-based recommendations for cervical ripening in term, singleton, vertex pregnancies with intact membranes. With 33.7% of US births involving induction and 84% of those patients requiring cervical ripening, this guideline directly shapes daily L&D nursing practice.

⚖️ Clinical Considerations

• Prostaglandins are contraindicated in patients with prior cesarean or uterine surgery; mechanical methods remain an option
• Combined balloon catheter plus 25 mcg misoprostol at 30 mL volume identified as safest, most effective strategy
• Outpatient ripening is conditionally recommended for low-risk patients using dinoprostone or balloon catheters
• Trauma-informed care requires assessing patient distress before choosing vaginal versus oral methods

🎯 Practice Applications

• Screen all induction patients for prior cesarean before initiating prostaglandin agents
• Document shared decision-making conversations including patient values and method preferences
• Apply trauma-informed assessment when selecting oral versus vaginal ripening method
• Educate patients that induction typically extends labor duration versus expectant management

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