In the absence of oligohydramnios, fetal distress, or sepsis, induction should be started if labor has not begun 48 to 72 hours after admission. Under normal conditions, the physiological process of cervical ripening takes approximately 3 weeks.3' An unripe cervix requires an average 10,000 mm Hg of uterine work to reach readiness for labor compared with only 1600 mmHg for a ripe cervix.3' Women who have an unripe cervix usually require long hours of oxytocin stimulation
to attain cervical ripeness. Meanwhile, anxiety tends to build for the impending delivery, and this leads to an increased tendency to use vaginal examinations to determine the cervical state. Without question, such examinations and other invasive procedures should be kept to a minimum, as they often traumatize the cervix and introduce infection under the best of circumstances.The patient should be hydrated and treated with antibiotics, while the fetus is monitored continuously. Septic complications occur four times more often (12% versus 3%) after routine induction than after spontaneous labor,22 although in every study that examined this question, similar proportions have not been found.32-35