Cook´s Balloon Versus Dinoprostone for Labor Induction of Term Pregnancies With Fetal Growth Restriction

The goal of this clinical trial is to compare how two methods for cervical ripening work in a population of singleton pregnancies with late-onset fetal growth restriction (FGR) at term. The main question it aims to answer is whether Cook´s balloon (a mechanical method) is superior to vaginal dinoprostone (a pharmacological method) in achieving a vaginal delivery. Participants will be randomized to receive Cook´s balloon (experimental group) or vaginal dinoprostone (control group) for cervical ripening. Researchers will compare both groups to see if Cook´s balloon is associated with a higher rate of vaginal delivery than vaginal dinoprostone. Neonatal outcomes (including neonatal acidosis, the MAIN morbidity score, and NICU admission) will be assessed as secondary, descriptive endpoints.

Inclusion Criteria: * Singleton pregnancy * Age ≥ 18 years * Gestational age (GA) dated by first trimester ultrasound ≥ 37+0 weeks * Cephalic presentation * Stage I fetal growth restriction, defined as the presence of at least one of these two criteria: 1. Estimated fetal weight (EFW) \< 3rd percentile 2. EFW \< 10th percentile and at least one of the following: 2.1) Umbilical artery pulsatility index \> 95th percentile or 2.2) Cerebral-placental index \< 5th percentile * Bishop score \< 7 * Intact fetal membranes * No previous caesarean section * No contraindications for vaginal delivery or labor induction. Exclusion Criteria: * Major fetal malformation * Fetal genetic abnormality * Fetal congenital infection