Intra-vaginal hydrosonography and cervical length assessment in pregnant women before induction of labour: A modified technique

The objective of this study was to demonstrate a new simple technique in introducing saline into the vagina during trans-vaginal scan. This technique will help to identify the cervical length properly when it is difficult to delineate the cervix. This is a prospective study, which included 104 pregnant women who booked to have induction of labour at term over a period of 3 years. Women who were included in the study underwent a transvaginal scan to measure cervical length. Sterile saline was introduced into the vagina using either an ordinary syringe or an Endosampler and the cervical length re-measured. When the outer border of the cervix was not clearly visualised, there was a highly statistically significant difference (p < 0.001) between the medians of pre-and post-saline cervical length measurements. In contrast, no significant difference between the medians (p > 0.05) was detected when the outer border of the cervix was clearly delineated. In those women, who had previous surgery to the cervix, it was very difficult to identify the cervix at all without the saline injection during transvaginal scanning. We conclude that intra-vaginal saline can be used as a contrast medium to help delineate the cervix if it is difficult to identify during transvaginal scan. The Endosampler makes the introduction of the saline into the vagina easy, controlled and well tolerated.

Comparison between subjective and objective assessments of the cervix before induction of labour

The aim of the study was to compare the pre-induction cervical assessment by Bishop's score with the transvaginal ultrasound cervical length as predictors of the induction-delivery interval (IDI) and the success of induction. This prospective study included 104 women with singleton pregnancies who were booked for induction of labour at term over a period of 3 years. Transvaginal ultrasound measurement of the cervical length and Bishop's Score were performed by different operators. Data were collected on parity, gestational age, methods of induction, Bishop's score, ultrasound cervical length measurements, IDI and mode of delivery. A total of 87 women (83.7%) delivered vaginally and 17 (16.3%) delivered by caesarean section. Linear regression models demonstrated that ultrasound cervical length was a better indicator of IDI than Bishop's score. The adjusted R2 for the regression including ultrasound cervical length was 0.87 compared with a value of 0.67 for the model including Bishop's score. Although logistic regression analysis confirmed that cervical effacement was the best component of Bishop's score to predict the mode of delivery, ultrasound cervical length assessment provided better prediction. Receiver operating characteristic curve showed that the optimised cut-off value for prediction of vaginal delivery was < or =3.4 cm for the cervical length and >5 for the Bishop's score. At those optimised cut-off values the cervical length predicted vaginal delivery with sensitivity of 62.1% (95% CI [51%, 72.3%]) and specificity of 100% (95% CI [80.5%, 100%]) while the Bishop's score predicted vaginal delivery with a sensitivity of 23% (95% CI [14.6%, 33.2%]) and specificity of 88.2% (95% CI [63.5%, 98.5%]). Further analysis showed that ultrasound cervical length has a higher sensitivity in prediction of vaginal delivery in multiparous than nulliparous women (85.1% compared with 35%) at a cut-off value of < or =3.4 cm. On the other hand, it has a higher sensitivity in nulliparous comparable with multiparous women (85.3% compared with 30%) in prediction of IDI at a cut-off value of >3.5 cm. In conclusion, transvaginal ultrasound cervical length assessment is better than Bishop's score in predicting the IDI and the success of induction of labour.

A way to lend objectivity to Bishop score

The aim of this study was to explore the possibility of utilising pre-induction cervical length assessment by trans-vaginal ultrasound to improve the predictive value of the Bishop score. The idea of this paper has evolved following our prospective study, which was designed to compare the pre-induction objective assessment of the cervix by ultrasound with the subjective one by Bishop Score. The Bishop scores of the 104 women included in the study were modified by replacing the digital assessment of the cervical length by ultrasound cervical length measurements. There was a significant statistical difference (p < 0.0001) between the median of the original and the modified Bishop scores. The original Bishop score showed insignificant association (p > 0.05) with the induction-delivery interval (IDI) and the mode of delivery while the modified score showed a significant association (r = 0.31, p < 0.05) with mode of delivery and a highly significant one (r = 0.55, p < 0.0001) with the IDI. The receiver operating characteristic curve showed that the optimised cut-off value for prediction of vaginal delivery was >5 for the original Bishop Score and >3 for the modified one. At those optimised cut-off values, the original Bishop Score predicted vaginal delivery with a sensitivity of 23% (95% CI; 14.6%, 33.2%) and specificity of 88.2% (95% CI; 63.5%, 98.5% while the modified Bishop score predicted vaginal delivery with a sensitivity of 62% [95%; CI 51 - 72.3] and specificity of 82% [95%; CI 56.6 - 96]). In conclusion, the modified Bishop score is better than the original one in predicting the IDI and the success of induction of labour. The sensitivity of the Bishop score in predicting the rate of vaginal delivery has been improved significantly following the modification.

A study of maternal plasma beta-endorphin in pre-eclamptic women during labour

This prospective study was undertaken to determine the maternal plasma beta-endorphin levels in pre-eclamptic women during labour and to explore any correlation between the levels and the severity of pre-eclampsia. A total of 50 primiparous women at term were recruited over a period of 5 years. Twenty-five with pre-eclampsia and 25 healthy women considered as a control group. The mean concentration of maternal plasma beta-endorphin in pre-eclamptic group (22.73+/-8.02 pmol/l) was significantly lower (p<0.001) than that of the control group (48.38+/-5.94 pmol/l). A highly significant (p<0.001) negative correlation was found between maternal plasma beta-endorphin levels and both systolic and diastolic blood pressures in pre-eclamptic group.

Vaginal sacrospinous fixation: experience in a district general hospital

This is an observational retrospective study, which included 77 patients who underwent sacrospinous fixation (SSF) over a period of 3 years in a district general hospital. Casenotes were reviewed and all patients were invited to attend a further review appointment (14-49 months). The object was to determine short- and long-term success of SSF,particularly in elderly (28% were > or = 70 years), obese (24.7%) and medically compromised (64.9%) patients. Fifty-two patients (67.5%) had previous gynaecological procedures, while the remaining 25 (32.5%) had no previous surgery. Intra- and postoperative complications were 3.9% and 32.5%, respectively. There was considerable relief of patients' symptoms at both short- and long-term followup, while the rate of recurrence of vault prolapse was 10.3%. Our experience suggests that SSF appears to be a safe and effective procedure, especially for those who may constitute surgical or anaesthetic risks. It has a reasonable success rate, good postoperative recovery and acceptable long-term results.