HNBB is Not a Recognized Method for Cervical Ripening
HNBB does not appear in any established obstetric guidelines, FDA-approved drug labels, or peer-reviewed literature as a method for cervical ripening. The acronym is not recognized by the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, or any other major obstetric organization. 1, 2, 3
Established Evidence-Based Methods for Cervical Ripening
Since HNBB is not a valid cervical ripening method, the following are the only guideline-supported approaches for an unfavorable cervix (Bishop score <5):
Pharmacologic Agents
Dinoprostone (PGE2) is FDA-approved for cervical ripening, administered as either 0.5 mg intracervically or 2-5 mg intravaginally, with a vaginal insert releasing approximately 0.3 mg/hour over a maximum of 12 hours. 2, 3
Oral misoprostol (20-25 µg every 2-6 hours) results in fewer cesarean sections (RR 0.84) and costs significantly less than dinoprostone, but is absolutely contraindicated in women with prior cesarean delivery due to a 13% uterine rupture risk. 2, 3
Wait at least 30 minutes after removing dinoprostone before starting oxytocin, and use continuous fetal heart rate and uterine activity monitoring throughout administration. 2, 3
Mechanical Methods
Foley catheter balloon is safe, effective, and preferred in women with cardiac disease, prior cesarean delivery, or contraindications to prostaglandins. 2, 4, 5
Mechanical methods have low cost, minimal systemic side effects, and low risk of uterine hyperstimulation compared to pharmacologic agents. 4
Critical Contraindications
Active cardiovascular disease is an absolute contraindication to dinoprostone due to profound blood pressure effects, theoretical risk of coronary vasospasm, and arrhythmias—use mechanical methods instead. 2
Prior cesarean delivery is a relative contraindication for prostaglandins; mechanical methods are strongly preferred, and misoprostol must never be used. 2, 3
Common Pitfall
Do not declare a failed induction before allowing at least 12 hours after completion of cervical ripening, membrane rupture, and oxytocin initiation. Nulliparous women often require 24+ hours total for successful induction. 2
If "HNBB" was intended to represent a different acronym or method, clarification is needed, as it does not correspond to any recognized cervical ripening intervention in current obstetric practice.