Hypertensive disorders complicate 5–10% of pregnancies, with pre-eclampsia (PE) and eclampsia accounting for 40,000–80,000 maternal deaths annually worldwide [1]. Magnesium sulphate and anti-hypertensives reduce morbidity and mortality, but PE resolves only after delivery [2]. The American College of Obstetricians & Gynecologists (ACOG) recommends vaginal delivery (VD), rather than a planned cesarean section (CS) among women with PE, as it is usually associated with a good outcome [3]. Coppage and Polzin reported that among 93 women with severe PE; 34/93 (36.6%) had a planned CS and 59/93 (63.4%) had induction of labor (IoL), of whom, 37/59 (63%) achieved VD and 22/59 (37%) required emergency CS [4]. Maternal pulmonary complications were more frequent after CS (planned or emergency) than VD (25 vs 8%; p < 0.05) and respiratory distress syndrome (RDS) was more common among neonates born by CS than VD (50 vs 19%; p < 0.05), showing that VD is preferable to CS [4]. Coviello et al reported that 46.4% women with preterm PE achieved VD after IOL, with more success at higher gestational age [5].Maternal condition in PE improves after delivery and prolonged labor may continue to worsen the maternal and fetal status until delivery, hence it may be advantageous to have a shorter induction-delivery interval (IDI). Additionally, many women may be preterm and require cervical ripening prior to IoL. Various methods like misoprostol, intracervical Foley’s catheter or osmotic dilators followed by oxytocin and intravaginal dinoprostone (PGE2) gel followed by oxytocin have been used [6], [7], [8], [9], [10]. A combined cervical ripening method (Foley’s plus prostaglandins) resulted in a shorter IDI with a similar rate of CS or tachysystole than Foley’s or prostaglandins used alone [11], [12], [13], [14], [15]. Levine et al found a shorter IDI with combined methods (Foley’s-misoprostol: 13.1 h, Foley’s-pitocin: 14.5 h, misoprostol alone: 17.6 h, Foley’s alone: 17.7 h, p < 0.001), with a similar CS and infection rate with all four methods [15]. However, some other studies reported a similar IDI and CS rate with combined or individual ripening methods [16], [17], [18]. The above mentioned studies reporting combined methods for cervical ripening have used repetitive doses of prostaglandins with Foley’s [11], [12], [13], [14], [15], [16], [17], [18]. In a previous study in our hospital, Foley’s combined with only a single dose of intracervical dinoprostone gel followed by oxytocin after 12 h resulted in a significantly shorter IDI than Foley’s alone followed by oxytocin after 12 h (16.2 vs 20.7 h, p = 0.02) with a similar CS rate (29.1 vs 25.5%; p = 0.66) [19]. We postulated that earlier initiation of oxytocin (6 h after cervical ripening) may reduce the IDI and expedite delivery as compared to initiation of oxytocin 12 h after cervical ripening, which may be beneficial for women with severe PE. In the present study, we have compared early (after 6 h) with standard initiation (after 12 h) of oxytocin following a combined method of cervical ripening among women with severe PE undergoing IOL.