Abstract
Pharmacological agents are often used to induce labor. Failed inductions are associated with unnecessarily long waits and greater maternal-fetal risks, as well as higher costs. No reliable models are currently able to predict the induction outcome from common obstetric data (area under the ROC curve (AUC) between 0.6 and 0.7). The aim of this study was to design an early success-predictor system by extracting temporal, spectral, and complexity parameters from the uterine electromyogram (electrohysterogram (EHG)). Different types of feature sets were used to design and train artificial neural networks: Set_1: obstetrical features, Set_2: EHG features, and Set_3: EHG+obstetrical features. Predictor systems were built to classify three scenarios: (1) induced women who reached active phase of labor (APL) vs. women who did not achieve APL (non-APL), (2) APL and vaginal delivery vs. APL and cesarean section delivery, and (3) vaginal vs. cesarean delivery. For Scenario 3, we also proposed 2-step predictor systems consisting of the cascading predictor systems from Scenarios 1 and 2. EHG features outperformed traditional obstetrical features in all the scenarios. Little improvement was obtained by combining them (Set_3). The results show that the EHG can potentially be used to predict successful labor induction and outperforms the traditional obstetric features. Clinical use of this prediction system would help to improve maternal-fetal well-being and optimize hospital resources.
Highlights
The induction of labor consists of promoting uterine contractions and cervical ripening before the onset of spontaneous labor
It should be noted that there is some controversy as regards establishing the value of the cervical dilatation and cervical effacement associated with active phase of labor (APL), in the present work, we considered 4 cm, being the most widely extended definition [21]
A total of 115 women with singleton pregnancies took part in the study. Their obstetric characteristics and labor induction outcome are summarized in Table 1. 98 women reached the active phase of labor, and 82 reached vaginal delivery. 33 ended up with a C-section: those who did not reach APL
Summary
The induction of labor consists of promoting uterine contractions and cervical ripening before the onset of spontaneous labor. This common procedure is indicated when continuing pregnancy increases maternal and/or fetal risks. Pharmacological labor induction is mainly obtained by prostaglandins [2] but can take up to 20 hours [3] and has been known to take more than 36 hours, with no guarantee of success. It has been associated with maternal and fetal risks such as abnormal uterine activity, fetal distress, and higher cesarean rates [4]. Predicting successful induction is an important aspect in improving maternal and fetal well-being, reducing healthcare costs and improving labor management
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