Abstract
Labor induction does not always result in vaginal delivery, and can expose both the mother and the fetus to the risks inherent to the induction procedure or a possible cesarean section. Transvaginal sonography (TVS) of the cervix is a useful tool to predict prematurity; in the present study, this tool was used to evaluate postterm induction. We evaluated the ultrasound characteristics of the cervix (cervical length, cervical funneling, internal os dilation, the presence or absence of the cervical gland area [CGA], and the morphological changes of the cervix as a result of applying fundal pressure) before the onset of labor induction among women with postterm pregnancy to identify the possible predictors of failed labor induction. The Bishop score (BS) was used for comparison purposes. Three groups were evaluated: successful versus unsuccessful induction; vaginal delivery versus cesarean delivery (excluding cases of acute fetal distress [AFD]); and vaginal delivery versus cesarean delivery (including cases of AFD). A fourth group including only the primiparous women from the three previous groups was also evaluated. Based on the studied characteristics and combinations of variables, a cervical length ≥ 3.0 cm and a BS ≤ 2 were the best predictors of induction failure. Although TVS is useful for screening for induction failure, this tool should not be used as an indication for cesarean section.
Highlights
Despite significant medical advances over the past few decades, the mechanisms that trigger the onset of labor have not yet fully understood
We evaluated the ultrasound characteristics of the cervix before the onset of labor induction among women with postterm pregnancy to identify the possible predictors of failed labor induction
Transvaginal sonography (TVS) is useful for screening for induction failure, this tool should not be used as an indication for cesarean section
Summary
Despite significant medical advances over the past few decades, the mechanisms that trigger the onset of labor have not yet fully understood. Inflammatory activity mediated by gene expression is one mechanism that regulates this process.[1,2,3,4,5,6] Given the lack of understanding of the factors that trigger labor, we frequently manage situations involving increased pregnancy risks, including postterm births (> 40 weeks of gestation), postmature births (> 42 weeks of gestation), and the complications commonly associated with these conditions.[7,8]. One strategy used to avoid postterm complications is to prevent the prolongation of pregnancy by initiating delivery. Two strategies can be used for this purpose: the induction of vaginal delivery or cesarean delivery. The incidence of cesarean births is high in Brazil, representing 50% of all births.[9,10,11] Cesarean birth considerably increases the risks for the mother while decreasing the morbidity for the fetus.[12,13] The induction of vaginal delivery increases the risks for both the mother and the fetus; these risks are markedly reduced in cases in which the procedure is well-supervised.[14–16]
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