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Kyvernitakis I, von Gehren F, Malan M, Baschat A, Maul H, Osinski M. Prediction of Preterm Birth with the Uterocervical Angle in Singleton Pregnancies Treated with a Cervical Pessary. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:190-198. [PMID: 37168018 DOI: 10.1055/a-2091-7179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cervical pessaries are an established therapy option for patients at risk for spontaneous preterm birth (sPTB). The uterocervical angle (UCA) remains a promising sPTB predictor. However, its clinical significance has yet to be described in patients treated with a pessary. METHODS This study analyzed data of patients treated with a pessary because of cervical shortening in singleton pregnancies. The patients were divided into 2 groups according to transvaginal ultrasound findings: the funneling group (n = 68) and the no-funneling group (n = 42). Moreover, we analyzed patients within these prespecified groups according to the UCA < 95° and ≥ 95°. RESULTS Delivery occurred significantly earlier in patients treated with a pessary and with a high UCA ≥ 95°(p = 0.006). The median gestational age at delivery in patients treated with a pessary and with no funneling and a UCA < 95° vs. ≥ 95° were 39.00 and 36.14 weeks, respectively (p = 0.005). In cases with funneling and a UCA < 95° vs. ≥ 95° the mean gestational age at delivery was 38.14 and 38.07 weeks respectively (p=1,00). There was a significant negative linear correlation between UCA and the gestational age at delivery in all patients (p = 0.04), which was even profound in the group without funneling (p = 0.0002). However, we found no significant correlation between cervical length and gestational age at delivery in all patients (p = 0.42) as well as in the group without funneling (p = 0.28). CONCLUSION In spite of pessary treatment, patients with UCA ≥ 95° presented with a higher risk of sPTB compared to patients with UCA < 95°. This suggests that the UCA seems to be a better predictor of sPTB than the cervical length in patients receiving pessary treatment.
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Affiliation(s)
- Ioannis Kyvernitakis
- Asklepios Clinic Barmbek, Departament of Obstetrics and Prenatal Medicine, Asklepios Medical School, University of Semmelweis, Hamburg, Germany
| | - Friederike von Gehren
- Asklepios Clinic Barmbek, Departament of Obstetrics and Prenatal Medicine, Asklepios Medical School, University of Semmelweis, Hamburg, Germany
| | - Marcel Malan
- Asklepios Clinic Barmbek, Departament of Obstetrics and Prenatal Medicine, Asklepios Medical School, University of Semmelweis, Hamburg, Germany
| | - Ahmet Baschat
- Gynecology & Obstetrics, Johns Hopkins University, Baltimore, United States
| | - Holger Maul
- Asklepios Clinic Barmbek, Departament of Obstetrics and Prenatal Medicine, Asklepios Medical School, University of Semmelweis, Hamburg, Germany
| | - Maciej Osinski
- Asklepios Clinic Barmbek, Departament of Obstetrics and Prenatal Medicine, Asklepios Medical School, University of Semmelweis, Hamburg, Germany
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Sinha P, Gupta M, Meena S. Comparing Transvaginal Ultrasound Measurements of Cervical Length to Bishop Score in Predicting Cesarean Section Following Induction of Labor: A Prospective Observational Study. Cureus 2024; 16:e54335. [PMID: 38500903 PMCID: PMC10945042 DOI: 10.7759/cureus.54335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Bishop score (BS) has been used to see the favorability of the cervix for induction of labor (IOL), but it has limitations in today's diverse patient population. We aimed to assess the predictive value of transvaginal ultrasound (TVUS) measurements of cervical length (CL) compared to BS in determining the likelihood of cesarean section (CS) following IOL. METHODOLOGY A prospective observational study was conducted on 120 women requiring IOL in a tertiary care hospital in central India. The inclusion criteria of the study were antenatal women more than 18 years of age, in need of IOL, having a singleton pregnancy with a gestational age of > 37 weeks as determined from the date of the last menstrual period and confirmed by sonographic measurements in the first trimester, presenting with a cephalic presentation, and having intact fetal membranes. Women with prior uterine scars and those unwilling to IOL were excluded from the study. TVUS was done just before induction. Statistical analyses were done to compare the predictive abilities of CL and BS for CS. RESULTS The mean age and gestation period were 25.96 years and 39 weeks 3 days, respectively. The majority of the study population comprised multigravida (69, 57.5%), followed by primigravida (47, 39.2%), and grand multigravida (≥ G5) (4, 3.3%). Post-maturity (34, 28.3%), preeclampsia (21, 17.5%), and intrahepatic cholestasis of pregnancy (17, 14.2%) were common indications for induction. The overall CS rate was 35.8% (43/120). Women with CS had lower BS (3.60 vs. 4.70, P = 0.010) and higher CL (31.5 mm vs. 23.4 mm, P < 0.001). CL exhibited an area under the curve (AUC) of 0.857, outperforming BS (AUC = 0.643) in predicting CS. Using a CL cutoff of 26.5 mm yielded sensitivity (79.1%), specificity (81.8%), and overall accuracy (80.8%). CONCLUSIONS TVUS measurement of CL (>26.5 mm) demonstrated superior predictive ability for CS following labor induction compared to BS (≤5). This study highlights the potential of CL measurement as an objective and reliable tool for optimizing decision-making in labor induction.
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Affiliation(s)
- Parul Sinha
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raebareli, Raebareli, IND
| | - Mansi Gupta
- Department of Obstetrics and Gynecology, Eras Lucknow Medical College and Hospital, Lucknow, IND
| | - Snehlata Meena
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raebareli, Raebareli, IND
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Bila J, Plesinac S, Vidakovic S, Spremovic S, Terzic M, Dotlic J, Kalezic Vukovic I. Clinical and ultrasonographic parameters in assessment of labor induction success in nulliparous women. J Matern Fetal Neonatal Med 2020; 33:3990-3997. [PMID: 31007104 DOI: 10.1080/14767058.2019.1594185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Evaluation of simplified Bishop score and ultrasound cervicometry in the assessment of labor induction success in nulliparous women.Methods: Prospective cohort study included 146 nulliparous women with singleton pregnancy and indications for labor induction. Prior to labor induction, cervicometry and Bishop score were determined. Upon delivery, patients were classified as those delivered vaginally and by cesarean section (CS) after unsuccessful labor induction.Results: Bishop score >5 was found in 47.95% of vaginally delivered women and 12.33% of patients delivered by CS (p < .01). Cervicometry had appropriate findings in 34.2% of vaginally delivered women and 75.3% of those delivered by CS (p < .01). Bishop score (>5 versus ≤5) had lower sensitivity (52.05%) and specificity (12.33%) than cervicometry (good versus unfavorable findings) (sensitivity 65.75%, specificity 75.34%) for prediction of labor induction success. If Bishop score was ≤5, cervicometry had 50.0% sensitivity and 78.13% specificity, while if Bishop score was >5, 82.86% sensitivity and 55.56% specificity. Obtained model for predicting labor induction outcome in nulliparous women based on their clinical and ultrasonographical characteristics identified the Bishop score as the most important predictor.Conclusions: Study confirmed the usefulness of simplified Bishop score and ultrasound cervicometry in the assessment of labor induction success in nulliparous women.
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Affiliation(s)
- Jovan Bila
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Snezana Plesinac
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Snezana Vidakovic
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Svetlana Spremovic
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Milan Terzic
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia.,Department of Medicine, Nazarbayev University, Astana, Kazakhstan.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan
| | - Jelena Dotlic
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia
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Kehila M, Abouda HS, Sahbi K, Cheour H, Chanoufi MB. Ultrasound cervical length measurement in prediction of labor induction outcome. J Neonatal Perinatal Med 2017; 9:127-31. [PMID: 27197935 DOI: 10.3233/npm-16915111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Induction of labor is one of the most common procedures in modern obstetrics, with an incidence of approximately 20% of all deliveries. Not all of these inductions result in vaginal delivery; some lead to cesarean sections, either for emergency reasons or for failed induction. That's why, It seems necessary to outline strategies for the improvement of the success rate of induced deliveries. Traditionally, the identification of women in whom labor induction is more likely to be successful is based on the Bishop score. However, several studies have shown it to be subjective, with high variation and a poor predictor of the outcome of labor induction. Transvaginal sonography for cervical measurement can be a more objective criterion in assessing the success of labor induction. Many studies have been done recently to compare cervical measurement and Bishop Score in labor induction.This paper reviewed the literature that evaluated sonographic cervical length measurement to predict induction of labor outcome.
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Affiliation(s)
- M Kehila
- C Department, Tunis Maternity and Neonatology Center, Tunis El Manar University, Tunis, Tunisia
| | - H S Abouda
- C Department, Tunis Maternity and Neonatology Center, Tunis El Manar University, Tunis, Tunisia
| | - K Sahbi
- Department of Gynecology, Hedi Chaker Teaching Hospital, sfax, Tunisia
| | - H Cheour
- C Department, Tunis Maternity and Neonatology Center, Tunis El Manar University, Tunis, Tunisia
| | - M Badis Chanoufi
- C Department, Tunis Maternity and Neonatology Center, Tunis El Manar University, Tunis, Tunisia
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Oros D, Garcia-Simon R, Clemente J, Fabre E, Romero MA, Montañes A. Predictors of perinatal outcomes and economic costs for late-term induction of labour. Taiwan J Obstet Gynecol 2017; 56:286-290. [PMID: 28600035 DOI: 10.1016/j.tjog.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE We aimed to predict the perinatal outcomes and costs of health services following labour induction for late-term pregnancies. MATERIALS AND METHODS We conducted a cohort study of 245 women who underwent labour induction during their 41st week of gestation. The cervical condition was assessed upon admission using the Bishop score and ultrasound cervical length measurements. We estimated the direct costs of labour induction, and a predictive model for perinatal outcomes was constructed using the decision tree analysis algorithm and a logit model. RESULTS A very unfavourable Bishop score at admission (Bishop score <2) (OR, 3.43 [95% CI, 1.77-6.59]), and a history of previous caesarean section (OR, 7.72 [95% CI, 2.43-24.43]) or previous vaginal delivery (OR, 0.24 [95% CI, 0.09-0.58]) were the only variables with predictive capacity for caesarean section in our model. The mean cost of labour induction was €3465.56 (95% confidence interval [CI], 3339.53-3591.58). Unfavourable Bishop scores upon admission and no history of previous deliveries significantly increased the cost of labour induction. Both of these criteria significantly predicted the likelihood of a caesarean section in the decision tree analysis. CONCLUSION The cost of labour induction mostly depends on the likelihood of successful trial of labour. Combined use of the Bishop score and previous vaginal or caesarean deliveries improves the ability to predict the likelihood of a caesarean section and the economic costs associated with labour induction for late-term pregnancies. This information is useful for patient counselling.
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Affiliation(s)
- Daniel Oros
- Instituto de Investigación Sanitaria de Aragón, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - Raquel Garcia-Simon
- Instituto de Investigación Sanitaria de Aragón, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Jesús Clemente
- Faculty of Economics and Business, University of Zaragoza, Spain
| | - Ernesto Fabre
- Instituto de Investigación Sanitaria de Aragón, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Manuel Angel Romero
- Instituto de Investigación Sanitaria de Aragón, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Antonio Montañes
- Faculty of Economics and Business, University of Zaragoza, Spain
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Abstract
BACKGROUND Induction of labour is the artificial initiation of labour in a pregnant woman after the age of fetal viability but without any objective evidence of active phase labour and with intact fetal membranes. The need for induction of labour may arise due to a problem in the mother, her fetus or both, and the procedure may be carried out at or before term. Obstetricians have long known that for this to be successful, it is important that the uterine cervix (the neck of the womb) has favourable characteristics in terms of readiness to go into the labour state. OBJECTIVES To compare Bishop score with any other method for assessing pre-induction cervical ripening in women admitted for induction of labour. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies to identify randomised controlled trials (RCTs). SELECTION CRITERIA All RCTs comparing Bishop score with any other methods of pre-induction cervical assessment in women admitted for induction of labour. Cluster-RCTs were eligible for inclusion but none were identified. Quasi-RCTs and studies using a cross-over design were not eligible for inclusion. Studies published in abstract form were eligible for inclusion if they provided sufficient information.Comparisons could include the following.1. Bishop score versus transvaginal ultrasound (TVUS).2. Bishop score versus Insulin-like growth factor binding protein-1 (IGFBP-1).3. Bishop score versus vaginal fetal fibronectin (fFN).However, we only identified data for a comparison of Bishop score versus TVUS. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the trials for inclusion, extracted the data and assessed trial quality. Data were checked for accuracy. MAIN RESULTS We included two trials that recruited a total of 234 women. The overall risk of bias was low for the two studies. Both studies compared Bishop score withTVUS.The two included studies did not show any clear difference between the Bishop score and TVUS groups for the following main outcomes: vaginal birth (RR 1.07, 95% CI 0.92 to 1.25, moderate quality evidence), caesarean delivery (RR 0.81, 95% CI 0.49 to 1.34, moderate quality evidence), neonatal admission into neonatal intensive care unit (RR 1.67, 95% CI 0.41 to 6.71, moderate quality evidence). Both studies only provided median data in relation to induction-delivery interval and reported no clear difference between the Bishop and TVUS groups. Perinatal mortality was not reported in the included studies.For the review's secondary outcomes, the need for misoprostol for cervical ripening was more frequent in the TVUS group compared to the Bishop score group (RR 0.52, 95% CI 0.41 to 0.66, two studies, 234 women, moderate quality evidence). In contrast, there were no clear differences between the Bishop scope and TVUS groups in terms of meconium staining of the amniotic fluid, fetal heart rate abnormality in labour, and Apgar score less than seven. Only one trial reported median data on the induction-delivery interval and induction to active phase interval, the trialist reported no difference between the Bishop group and the TVUS group for this outcome. Neither of the included studies reported on uterine rupture. AUTHORS' CONCLUSIONS Moderate quality evidence from two small RCTs involving 234 women that compared two different methods for assessing pre-induction cervical ripening (Bishop score and TVUS) did not demonstrate superiority of one method over the other in terms of the main outcomes assessed in this review. We did not identify any data relating to perinatal mortality. Whilst use of TVUS was associated with an increased need for misoprostol for cervical ripening, both methods could be complementary.The choice of a particular method of assessing pre-induction cervical ripening may differ depending on the environment and need where one is practicing since some methods (i.e. TVUS) may not be readily available and affordable in resource-poor settings where the sequelae of labour and its management is prevalent.The evidence in this review is based on two studies that enrolled a small number of women and there is insufficient evidence to support the use of TVUS over the standard digital vaginal assessment in pre-induction cervical ripening. Further adequately powered RCTs involving TVUS and the Bishop score and including other methods of pre-induction cervical ripening assessment are warranted. Such studies need to address uterine rupture, perinatal mortality, optimal cut-off value of the cervical length and Bishop score to classify women as having favourable or unfavourable cervices and cost should be included as an outcome.
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Affiliation(s)
- Ifeanyichukwu U Ezebialu
- Faculty of Clinical medicine, College of Medicine, Anambra State University AmakuDepartment of Obstetrics and GynaecologyAwkaNigeria
| | - Ahizechukwu C Eke
- Michigan State University School of Medicine/Sparrow HospitalDepartment of Obstetrics and Gynecology1322 East Michigan AvenueSuite 220LansingUSA48912
| | - George U Eleje
- Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi CampusEffective Care Research Unit, Department of Obstetrics and GynaecologyPMB 5001, NnewiNigeria
| | - Chukwuemeka E Nwachukwu
- Excellence & Friends Management Consult (EFMC)Plot 506 Cadastral Zone, Kubwa Ext II,Arab Road, KubwaAbujaNigeria
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Papillon-Smith J, Abenhaim HA. The role of sonographic cervical length in labor induction at term. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:7-16. [PMID: 25243838 DOI: 10.1002/jcu.22229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/25/2014] [Accepted: 07/26/2014] [Indexed: 06/03/2023]
Abstract
The purpose of this study is to review the literature examining the role of ultrasound in the induction of labor. Databases including Ovid, PubMed, Web of Science, Google Scholar, and UpToDate were searched and current guidelines from the SOGC, the ACOG, the RCOG, and the RANZCOG were reviewed. Although studies have not demonstrated the superiority of cervical sonography to the Bishop score, the evidence indicates that sonography could be useful in planning induction of labor, significantly reducing the need for cervical ripening agents. A more comprehensive method integrating both sonography and digital exam may be more appropriate.
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Affiliation(s)
- Jessica Papillon-Smith
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, 5790, Cote-Des-Neiges Road, H412, Montreal, Quebec, H3T 1E2, Canada
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Garcia-Simon R, Oros D, Gracia-Cólera D, Moreno E, Paules C, Cañizares S, Gascón E, Fabre E. Cervix assessment for the management of labor induction: Reliability of cervical length and Bishop score determined by residents. J Obstet Gynaecol Res 2014; 41:377-82. [DOI: 10.1111/jog.12553] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/28/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Raquel Garcia-Simon
- Obstetrics Department; University Hospital of Lozano Blesa; Zaragoza Spain
- Institute of Health Sciences; Zaragoza Spain
| | - Daniel Oros
- Obstetrics Department; University Hospital of Lozano Blesa; Zaragoza Spain
- Institute of Health Sciences; Zaragoza Spain
- Obstetrics and Gynaecology Department; University of Zaragoza; Zaragoza Spain
| | - Daniel Gracia-Cólera
- Obstetrics Department; University Hospital of Lozano Blesa; Zaragoza Spain
- Institute of Health Sciences; Zaragoza Spain
| | - Esther Moreno
- Obstetrics Department; University Hospital of Lozano Blesa; Zaragoza Spain
- Institute of Health Sciences; Zaragoza Spain
| | - Cristina Paules
- Obstetrics Department; University Hospital of Lozano Blesa; Zaragoza Spain
- Institute of Health Sciences; Zaragoza Spain
| | - Silvia Cañizares
- Obstetrics Department; University Hospital of Lozano Blesa; Zaragoza Spain
- Institute of Health Sciences; Zaragoza Spain
| | - Elena Gascón
- Obstetrics Department; University Hospital of Lozano Blesa; Zaragoza Spain
- Institute of Health Sciences; Zaragoza Spain
| | - Ernesto Fabre
- Obstetrics Department; University Hospital of Lozano Blesa; Zaragoza Spain
- Institute of Health Sciences; Zaragoza Spain
- Obstetrics and Gynaecology Department; University of Zaragoza; Zaragoza Spain
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Verhoeven CJM, Opmeer BC, Oei SG, Latour V, van der Post JAM, Mol BWJ. Transvaginal sonographic assessment of cervical length and wedging for predicting outcome of labor induction at term: a systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:500-8. [PMID: 23533137 DOI: 10.1002/uog.12467] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/02/2013] [Accepted: 03/14/2013] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis to assess the predictive capacity of transvaginal sonographic assessment of the cervix for the outcome of induction of labor. METHODS We searched MEDLINE, EMBASE and the Cochrane Library, and manually searched reference lists of review articles and eligible primary articles. Studies in all languages were eligible if published in full. Two reviewers independently selected studies and extracted data on study characteristics, quality and test accuracy. We then calculated pooled sensitivities and specificities (with 95% CIs) and summary receiver-operating characteristics (sROC) curves. Outcome measures were test accuracy of sonographically measured cervical length and cervical wedging for Cesarean section, not achieving vaginal delivery within 24 h and not achieving active labor. RESULTS We included 31 studies reporting on both cervical length and outcome of delivery. The quality of the included studies was mediocre. Sensitivity of cervical length in the prediction of Cesarean delivery ranged from 0.14 to 0.92 and specificity ranged from 0.35 to 1.00. The estimated sROC curve for cervical length indicated a limited predictive capacity in the prediction of Cesarean delivery. Summary estimates of sensitivity/specificity combinations of cervical length at different cut-offs for Cesarean delivery were 0.82/0.34, 0.64/0.74 and 0.13/0.95 for 20, 30 and 40 mm, respectively. For cervical wedging in the prediction of failed induction of labor summary point estimates of sensitivity/specificity were 0.37/0.80. CONCLUSIONS Cervical length and cervical wedging as measured sonographically at or near term have moderate capacity to predict the outcome of delivery after induction of labor.
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Affiliation(s)
- C J M Verhoeven
- Department of Obstetrics & Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
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Cubal A, Carvalho J, Ferreira MJ, Rodrigues G, Carmo OD. Value of Bishop score and ultrasound cervical length measurement in the prediction of cesarean delivery. J Obstet Gynaecol Res 2013; 39:1391-6. [DOI: 10.1111/jog.12077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 01/08/2013] [Indexed: 11/30/2022]
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Melamed N, Yariv O, Hiersch L, Wiznitzer A, Meizner I, Yogev Y. Labor induction with prostaglandin E2: characteristics of response and prediction of failure. J Matern Fetal Neonatal Med 2012; 26:132-6. [PMID: 22928537 DOI: 10.3109/14767058.2012.722729] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To characterize the response to labor induction with prostaglandin E2 (PGE2) and to identify risk factors for induction failure. METHODS A prospective controlled study of women admitted for labor induction with PGE2. Maternal characteristics, Bishop score and sonographic cervical length were documented at admission. The change in cervical characteristics and the emergence of uterine contractions following each application of PGE2 were analyzed. RESULTS Of the 88 women who were included in the study, 19 (21.6%) failed to response to PGE2. The following factors were independently associated with induction failure: nulliparity (odds ratio [OR] = 5.9, 95% confidence interval (CI): 1.2-30.2), pre-pregnancy body mass index >25 kg/m2 (OR = 5.4, 95% CI: 1.1-26.5), Bishop score <4 (OR = 2.3, 95% CI: 1.05-14.4), cervical length <25 mm (OR = 0.2, 95% CI: 0.1-0.8) and the development of uterine contractions in response to the first application of PGE2 (OR = 0.4, 95% CI: 0.1-0.93). Overall, most women required only one (60.9%) or two (85.5%) applications of PGE2 to achieve successful induction. The number of applications of PGE2 required to achieve successful induction was related to parity and cervical status at presentation. CONCLUSIONS Overall, most women who eventually respond to PGE2 do so following the first two applications of PGE2, and the contribution of subsequent applications is relatively small and related to cervical status at admission.
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Affiliation(s)
- Nir Melamed
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
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The Bishop Score as a determinant of labour induction success: a systematic review and meta-analysis. Arch Gynecol Obstet 2012; 286:739-53. [PMID: 22546948 DOI: 10.1007/s00404-012-2341-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
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Gómez-Laencina AM, García CP, Asensio LV, Ponce JAG, Martínez MS, Martínez-Vizcaíno V. Sonographic cervical length as a predictor of type of delivery after induced labor. Arch Gynecol Obstet 2011; 285:1523-8. [DOI: 10.1007/s00404-011-2178-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 12/12/2011] [Indexed: 05/26/2023]
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Bastani P, Hamdi K, Abasalizadeh F, Pourmousa P, Ghatrehsamani F. Transvaginal ultrasonography compared with Bishop score for predicting cesarean section after induction of labor. Int J Womens Health 2011; 3:277-80. [PMID: 21892338 PMCID: PMC3163657 DOI: 10.2147/ijwh.s20387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Indexed: 11/23/2022] Open
Abstract
Background: Reproductive health researchers are interested in finding better methods for predicting an unwanted type of delivery after induction of labor. The aim of this study was to compare the value of transvaginal ultrasonography findings and the Bishop score in predicting cesarean section after induction of labor. Methods: Two hundred women with singleton pregnancies undergoing induction of labor at 37–42 weeks were enrolled in this prospective study. Transvaginal investigation was done for all participants prior to induction. To compare the predictive value of the methods, receiver-operating characteristic (ROC) curves were plotted and equality of the area under curve (AUC) was tested. Results: The mean age of the participants was 29.9 years, mean gestational age was 39.6 weeks, and mean gravid was 1.5. The AUC calculated for Bishop score was 0.39 (95% confidence interval [CI] 0.3–0.48). The AUC for cervical length measured by ultrasonography was 0.69 (95% CI 0.6–0.77). The AUC for the posterior cervical angle measured by ultrasonography was 0.38 (95% CI 0.29–0.47). Testing equality of the ROC curves for these three methods showed the ROC for cervical length to be statistically different from both Bishop score and posterior cervical angle (P < 0.001). However, the difference in ROC area compared between Bishop score and posterior cervical angle was not statistically significant. Conclusion: Based on our findings and available information in the literature, it seems that cervical length measured by transvaginal ultrasonography has the potential to replace the traditional Bishop score, provided that such a facility is available when needed.
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Affiliation(s)
- Parvin Bastani
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Mandruzzato G, Alfirevic Z, Chervenak F, Gruenebaum A, Heimstad R, Heinonen S, Levene M, Salvesen K, Saugstad O, Skupski D, Thilaganathan B. Guidelines for the management of postterm pregnancy. J Perinat Med 2010; 38:111-9. [PMID: 20156009 DOI: 10.1515/jpm.2010.057] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A pregnancy reaching 42 completed weeks (294 days) is defined as postterm (PT). The use of ultrasound in early pregnancy for precise dating significantly reduces the number of PT pregnancies compared to dating based on the last menstrual period. Although the fetal, maternal and neonatal risks increase beyond 41 weeks, there is no conclusive evidence that prolongation of pregnancy, per se, is the major risk factor. Other specific risk factors for adverse outcomes have been identified, the most important of which are restricted fetal growth and fetal malformations. In order to prevent PT and associated complications routine induction before 42 weeks has been proposed. There is no conclusive evidence that this policy improves fetal, maternal and neonatal outcomes as compared to expectant management. It is also unclear if the rate of cesarean sections is different between the two management strategies. After careful identification and exclusion of specific risks, it would seem appropriate to let women make an informed decision about which management they wish to undertake. There is consensus that the number of inductions necessary to possibly avoid one stillbirth is very high. If induction is preferred, procedures for cervical ripening should be used, especially in nulliparous women. Close intrapartum fetal surveillance should be offered, irrespective of whether labor was induced or not.
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Londero AP, Bertozzi S, Fruscalzo A, Driul L, Marchesoni D. Ultrasonographic assessment of cervix size and its correlation with female characteristics, pregnancy, BMI, and other anthropometric features. Arch Gynecol Obstet 2010; 283:545-50. [PMID: 20145939 DOI: 10.1007/s00404-010-1377-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 01/19/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Cervical length during the first trimester of pregnancy has not been completely investigated yet. The objective of our study is to compare cervical size in the first ten gestational weeks with that of non-pregnant women, and to determine its correlation with maternal factors, including age, anthropometric features, and reproductive history. METHODS We collected retrospective data about women who applied to the Obstetrics and Gynecology Outpatients Facility of Udine between February and June 2009, selecting both pregnant and non-pregnant women possessing a transvaginal ultrasonographic measurement of their cervix, and focusing on their age, parity, BMI, cervical, and uterine size. Data were analyzed by R (version.2.8.0), considering significant P < 0.05. RESULTS 135 women were recruited. By multivariate linear regression, both cervical length and width result independently influenced by pregnancy status, and among non-pregnant nullipara, cervical length results to be significantly lower in women younger than 20 (P < 0.05). CONCLUSIONS During the first ten gestational weeks, cervix results to be longer and wider than in non-pregnant women, suggesting the possible existence of early gestational, morphological, uterine, and cervical modifications. Women under the age of 20 have a significantly shorter cervix, suggesting an incomplete cervix maturity in this group of women, which may justify the higher prevalence of pre-term births in teenage pregnancies.
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Affiliation(s)
- A P Londero
- Clinic of Obstetrics and Gynecology, University Hospital of Udine, p.le SSMM Misericordia 15, 33100 Udine, Italy.
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