Ripening Approaches for Prompt Induction and Delivery - Sequential Versus Concurrent Dilapan-S and Misoprostol to Achieve Vaginal Delivery (RAPID-DS)

The purpose of this study is to compare the effectiveness of sequential versus combined multimodal cervical ripening strategies to achieve vaginal delivery within 24 hours among nulliparous patients with singleton, vertex pregnancies at term undergoing induction of labor.

Inclusion Criteria: * Nulliparous patients with singleton pregnancies with vertex lie at term receiving prenatal care that are eligible for outpatient cervical ripening will be eligible Exclusion Criteria: * age less than 18, * suspected major fetal anomalies (including suspected or proven chromosome anomalies, congenital cardiac disease expected to require neonatal intervention, and multiple anomalies suggestive of a complex syndrome), * fetal growth restriction * oligohydramnios * prior full thickness * uterine scar * placenta previa, * low-lying placenta, * premature rupture of amniotic membranes, * cervical dilation \> 2 cm * modified Bishop score \> 4 * residence greater than 60 minutes from the hospital