Method	Dose	Adverse effects	Advantages	Disadvantages	Uses	Precautions
Balloon catheter: single balloon (Foley catheter) or double balloon	—	—	Can be considered for outpatient cervical ripening Cost-effective	Discomfort with insertion	Useful for minimally dilated cervix and if fetus is not tolerant of other cervical ripening methods Combination of Foley catheter and misoprostol was more effective than single-agent cervical ripening in a small randomized controlled trial34	Mucopurulent cervicitis, rupture of membranes
Hygroscopic dilators: Dilapan-S rods, laminaria35,36	Usually 3 to 5 for Dilapan-S and 1 to 2 for laminaria	Bleeding, infection	Can be considered for outpatient cervical ripening Tolerable, easy to use, cost-effective Fetal monitoring not needed during ripening process	—	Ripening for closed cervix	Presence of genital tract infection
Dinoprostone37,38	0.5-mg gel 10-mg vaginal insert	Nausea/upset stomach, vomiting, diarrhea, flushing, pyrexia	Insert easily removed to reverse effects	Increased time from placement to delivery Expensive ($450 per insert, estimated lowest GoodRx price [no generic available])	Ripening for closed cervix	Presence of genital tract infection Uterine scar
Misoprostol (Cytotec, prostaglandin1 analogue)38–41	25 mcg intravaginally 50 mcg orally (sublingual or buccal)	Pyrexia, abdominal pain, shivering, nausea, diarrhea	Inexpensive (50 cents per 100-mcg tablet, estimated lowest GoodRx price for generic)	Uterine tachysystole more common Inability to reverse effects if there are abnormal changes	Ripening for closed cervix Use in combination with cervical ripening balloon increases likelihood of vaginal delivery within 24 hours34,35	Uterine scar
Oxytocin (Pitocin)	10 units in 1,000 mL of normal saline 1 to 2 mU per minute, titrated to establish contraction pattern Low-dose regimen: start at 0.5 to 2 mU per minute, and increase by 1 to 2 mU per minute every 15 to 40 minutes to a maximum of 32 mU per minute High-dose regimen: start at 6 mU per minute, and increase by 3 to 6 mU per minute every 15 to 40 minutes to a maximum of 40 mU per minute1,42,43	Nausea, vomiting, water intoxication in high doses	Because of its short half-life, oxytocin can be titrated to desired effect and discontinued as needed if there are abnormal fetal heart rate changes Can be used for cervical ripening in trial of labor after cesarean delivery	Longer time from induction to vaginal delivery compared with other methods	Cervical ripening, especially in patients with prior cesarean delivery or uterine surgery Induction/augmentation after cervical ripening	—