Likelihood Of Vaginal Delivery Research Articles

Relationship between Perceived Quality of Prenatal Care and Maternal/Infant Health Outcomes.

Studies have shown that quality of care affects patient health outcomes and well-being. In this study, we examine the relationship between perceived quality of prenatal care, birth outcomes, and postpartum depression (PPD). We use data from the third wave of the Listening to Mothers dataset (2013). After removing missing data, the analytic sample size included 2168 women. Through linear and logistic regression analyses, we test the following hypotheses: higher perceived quality of prenatal care will have a positive association with a likelihood of vaginal delivery and normal birth weight outcomes, and a negative association with a likelihood of preterm birth; and higher perceived quality of prenatal care will have a negative association with a likelihood of PPD risk. Women who perceived higher quality of prenatal care were significantly less likely to have a preterm birth relative to women who reported lower quality care. Women who reported (any) medical jargon during their prenatal visits were less likely to have a normal birth weight baby. Women who reported provider use of medical jargon, lower perceived quality of interaction with a prenatal care provider, and lower perceived quality of US maternity care in general were more likely to be at risk for PPD. Negative prenatal care experiences may exacerbate adverse patient outcomes. Positive prenatal care experiences may buffer/improve adverse outcomes. Quality of care measures were most consistently predictive of PPD outcomes. Providers should focus on improving the quality of prenatal care as one of the means to improve maternal and infant health and well-being.

Transvaginal two-dimensional ultrasound measurement of cervical volume to predict the outcome of the induction of labour: a prospective observational study

BackgroundAssessing the likelihood of success of induction of labour using ultrasonically measured cervical volume is an important research question.MethodA prospective observational study was carried out at North Colombo Teaching Hospital, Ragama, Sri Lanka. Pre-induction digital cervical assessment, transvaginal cervical length, and cervical volume measurements were performed. Inductions with singleton pregnancies at term were included. Basic demographic and clinical details, independent variables (Bishop score, cervical length and cervical volume), and dependent variables (frequency of delivery within 24 h and induction to delivery interval) were recorded. Vaginal delivery within 24 h was the primary outcome.ResultsWe studied 100 pregnant women who had induction of labour. Median (IQR) Bishop score was 5 (3–6), mean (SD) cervical length was 3.6 (0.7) cm, and mean (SD) cervical volume was 27.5 (10.4) cm3. Cervical length was the best predictor for predicting the likelihood of vaginal delivery within 24 h [aOR – 12.12 (3.44, 42.71); < 0.001], and cervical volume also appeared to be a significant potential predictor [aOR-1.10 (1.01, 1.17); 0.01]. Cervical length was found to have the highest AUC (0.83) followed by the cervical volume (0.74). The best cut-off value for cervical volume in predicting the likelihood of vaginal delivery within 24 h was less than 28.5 cm3 with a sensitivity of 72% and specificity of 74%.ConclusionsTransvaginal sonographic measurement of cervical volume appears to be a potential novel predictor for the likelihood of vaginal delivery within 24 h of induction of labour. Cervical length is still more superior to cervical volume in predicting the likelihood of vaginal delivery. Bishop score was not a significant predictor in this context.

Does Fetal Fibronectin Predict the Delivery Route in Nulliparous Women at Postterm Induced by Dinoprostone?

Objective: Digital cervical evaluation has been used to determine the likelihood of vaginal delivery which is considered by many women to be non-tolerable. Recently, alternative approaches such as transperineal ultrasound, fetal fibronectin test in cervicovaginal secretions have been investigating for the prediction of the delivery route. We aimed to study whether the usefulness of qualitative fetal fibronectin test in cervicovaginal secretions for the prediction of vaginal delivery in pregnant women at postterm induced with dinoprostone.Study design: A total of 32 nulliparous pregnant women at postterm were enrolled in this prospective observational study. Fetal fibronectin test was applied to all participated women before the induction with dinoprostone and transvaginal ultrasonography was performed to measure cervical length.Results: The women having positive fetal fibronectin test result gave birth through vaginal route, except one case. Although there is no statistically significant difference, the shorter cervical length was associated with vaginal delivery in our population.Conclusion: Fetal fibronectin test has a predictive value for delivery route in nulliparous women at postterm. Fetal fibronectin test may be used as a “rule out” test because the rate of fetal fibronectin positivity was found to be higher in patients who gave birth via vaginal route. As also shown in our study, although there is no statistically significant difference, the pregnant women with shorter cervical length might have a high possibility to achieve vaginal delivery.

Comparison of two management options for labor induction following unsuccessful prostaglandin E2 ripening

Objective We sought to compare the likelihood of a vaginal delivery (VD) using oxytocin, with and without a cervical ripening balloon, in nulliparous women who did not respond to initial ripening with prostaglandin E2 (PGE2). Methods We a performed a retrospective cohort study of nulliparous women with a singleton pregnancy at term who underwent cervical ripening with vaginal PGE2 between October 2015 and March 2019. Patients who did not respond to PGE2 ripening (bishop score (BS) of 6 or less with cervical dilation less than 3 cm) were stratified into two groups based on management: sequential ripening with a cervical ripening balloon in addition to oxytocin versus oxytocin alone. Patients who had PGE2 for less than 6 h, a BS greater than 6 after ripening, rupture of membranes or missing data were excluded. The primary outcome was VD. Secondary outcomes included VD within 24 h of induction, time from induction to delivery, rates of chorioamnionitis and postpartum hemorrhage, presence of meconium, neonatal birthweight, NICU admission, 5 min apgar < 5, and umbilical cord pH < 7. Statistical analysis included Chi-squared, Fisher’s exact and Mann-Whitney U tests, as well as logistic regression. Odds ratios (ORs) were calculated and adjusted for significant confounders using backwards-stepwise logistic regression. For time to delivery, a Cox proportional hazard regression was used to determine the hazard ratio (HR) and adjusted HR. Results 840 patients underwent cervical ripening with PGE2 during the study period. After the exclusion criteria were applied, 272 cases comprised the study cohort. Of those, 123 (45%) continued labor induction with a cervical ripening balloon and oxytocin and 149 (55%) continued labor induction with oxytocin alone. Baseline characteristics such as age, BMI, ethnicity, gestational age at induction and number of women undergoing elective induction were similar between both groups. There was no statistically significant difference in the likelihood of VD (oxytocin and cervical ripening balloon: 62.6% vs. oxytocin alone: 50.3%; a OR 1.61, p = .07) or rate of secondary outcomes between the two groups. Patients in the oxytocin alone group had a higher BS after PGE2 ripening, although both were very low (3 vs. 2, p < .0001).”. Additionally, there were significantly more patients undergoing full PGE2 ripening for 12 h in the cervical ripening balloon and oxytocin group compared to oxytocin alone (65.9% vs. 49.7%, p = .02). Conclusion Our data did not show a difference in VD rate in nulliparous women unresponsive to PGE2 ripening who underwent continued induction with oxytocin and cervical ripening balloon compared to oxytocin alone. Larger studies investigating the utility of sequential ripening and determining the optimal induction method following unsuccessful ripening are needed.

Finding the Breech: Influence of Breech Presentation on Mode of Delivery Based on Timing of Diagnosis, Attempt at External Cephalic Version, and Provider Success With Version

(Birth. 2017;44(3):222–229) Breech presentation accounts for 10% to 15% of cesarean deliveries in the United States. Cesarean delivery presents maternal risks and risk for future pregnancies. External cephalic version has a 60% success rate and is effective in decreasing cesarean deliveries. Optimal timing for external cephalic version is 36 to 37 weeks. At a later gestational age, advanced labor or rupture of membranes may prevent external cephalic version. This study investigated the connection between gestational age when breech presentation is diagnosed and the likelihood of a vaginal delivery, hypothesizing that the likelihood of vaginal delivery and external cephalic version would decrease if there was a failure to diagnose breech presentation before 38 weeks’ gestation.

Second-trimester cervical length and outcomes of induction of labor at term

Objective: To evaluate whether second-trimester cervical length (CL) is associated with induction of labor (IOL) outcomes. Methods: Retrospective cohort study of nulliparous singletons undergoing CL screening at 18 0/7–23 6/7 weeks from 1/1/2012 to 12/31/2013. Women induced at term (≥37 weeks) were included. Primary outcome was vaginal delivery (VD) within 24 h. The effect of CL on outcomes was assessed by incidence across CL quartiles and a receiver operating characteristics (ROC) curve. Odds ratios (OR) were adjusted (aOR) for confounders. Results: Two-hundred-and-sixty-eight women were included. Aside from a difference in incidence of prior cervical surgery between CL quartiles (p <. 02), other characteristics were similar. Ninety-two women (35%) had a VD within 24 h (versus a CD or VD >24 h). A longer a CL was associated with a decreased likelihood of a VD within 24 h with aORs of the third and fourth quartiles of 0.35 (0.16–0.75) and 0.43 (0.21–0.90), respectively, compared to the first quartile. A CL >40 mm was predictive of not having a VD within 24 h with a sensitivity of 56%, specificity of 58% and a positive predictive value of 72%. Conclusion: A second-trimester CL >40 mm is associated with a decreased likelihood of VD within 24 h in an IOL.

Ultrasound examination at term for predicting the outcome of delivery in women with a previous cesarean section

Objective: To evaluate if ultrasound variables at term are associated with the mode of delivery in women with previous cesarean section (PCS).Methods: This was a prospective study of singleton pregnant women who planned a trial of vaginal birth after cesarean delivery. Cervical length, posterior cervical angle, head–perineum distance, and estimated fetal weight were measured at 37–39 weeks of gestation.Results: One hundred forty-four pregnancies were examined and vaginal delivery was achieved in 98 women (73%). Logistic regression analysis identified cervical length, head–perineum distance, age, previous vaginal delivery, previous cesarean for dystocia, and Bishop score as predictors of vaginal delivery. Combining ultrasound and clinical parameters, two models for risk scoring that differ in the variable Bishop score or cervical length were constructed. The AUC of these models was 0.867 and 0.855, respectively.Conclusions: In women with a PCS, measurement of cervical length and head–perineum distance at term is associated with the mode of delivery. A combination of clinical and sonographic parameters at term can predict the likelihood of vaginal delivery.

428: Rates of severe maternal and neonatal adverse outcomes according to predicted likelihood of vaginal delivery

428: Rates of severe maternal and neonatal adverse outcomes according to predicted likelihood of vaginal delivery

Risk factors for cesarean delivery in twin pregnancies attempting vaginal delivery

The purpose of this study was to estimate independent risk factors for cesarean delivery in patients with twin pregnancies who attempt vaginal delivery. This was an historic cohort of twin pregnancies that were delivered in 1 practice from June 2005 to February 2014. Baseline characteristics were compared between women who delivered vaginally and women who underwent cesarean delivery in labor. Logistic regression analysis was performed to estimate independent risk factors for cesarean delivery. Two hundred eighty-six women with twin pregnancies who had attempted vaginal delivery were included in the study. The overall modes of delivery were vaginal delivery (82.2%), cesarean delivery (17.8%), and combined vaginal-cesarean delivery (0%). The most common indication for cesarean delivery in labor was an arrest disorder (82.4%). The risk factors that were associated independently with cesarean delivery were nulliparity (adjusted odds ratio, 5.78; 95% confidence interval, 2.24-14.88) and advanced maternal age of ≥35 years (adjusted odds ratio, 2.36; 95% confidence interval, 1.16-4.80). The patients at highest risk for cesarean delivery (nulliparous, advanced maternal age, induced labor) still had a 48.6% likelihood of vaginal delivery. In patients with twin pregnancies who attempt labor, nulliparity and advanced maternal age are associated independently with cesarean delivery in labor. However, even the patients at highest risk for cesarean delivery have nearly a 50% likelihood of successful vaginal delivery and therefore should be allowed to attempt vaginal delivery if it is desired and not otherwise contraindicated.

Sonographic prediction of vaginal delivery in prolonged labor: a two‐center study

To investigate whether head-perineum distance (HPD) measured by transperineal ultrasound is predictive of vaginal delivery and time remaining in labor in nulliparous women with prolonged first stage of labor and to compare the predictive value with that of angle of progression (AoP). This was a prospective observational study at Stavanger University Hospital, Norway and Addenbrooke's Hospital, Cambridge, UK from January 2012 to April 2013, of nulliparous women with singleton pregnancies with cephalic presentation at term with prolonged first stage of labor. We used transperineal ultrasound to measure HPD (shortest distance between the outer bony limit of the fetal skull and the perineum) and AoP (angle between a line through the long axis of the symphysis and the tangent to the fetal head) and transabdominal ultrasound to classify fetal head position. The main outcomes were vaginal delivery and time remaining in labor. Of 150 women enrolled, 39 underwent delivery by Cesarean section. The area under the receiver-operating characteristics curve for the prediction of vaginal delivery was 81% (95% CI, 73-89%) using HPD as the test variable and 72% (95% CI, 63-82%) using AoP. HPD was ≤ 40 mm in 84 (56%) women, of whom 77 (92%; 95% CI, 84-96%) delivered vaginally. HPD was > 40 mm in the other 66 (44%) women, of whom 34 (52%; 95% CI, 40-63%) delivered vaginally. AoP was ≥ 110° in 84 of the 145 (58%) in whom this was available and, of these, 74 (88%; 95% CI, 79-93%) delivered vaginally. AoP was < 110° in the other 61 (42%) women, of whom 35 (57%; 95% CI, 45-69%) delivered vaginally. Multivariable logistic regression analysis showed that HPD ≤ 40 mm (odds ratio (OR), 4.92; 95% CI, 1.54-15.80), AoP ≥ 110° (OR, 3.11; 95% CI, 1.01-9.56), non-occiput posterior position (OR, 3.36; 95% CI, 1.24-9.12) and spontaneous onset of labor (OR, 4.44; 95% CI, 1.42-13.89) were independent predictors for vaginal delivery. Both ultrasound methods were predictive for the time remaining in labor. Transperineal ultrasound measurement of HPD and AoP provide important information about the likelihood of vaginal delivery and the time remaining in labor in nulliparous women with prolonged labor.

Strength of preference for vaginal birth as a predictor of delivery mode among women who attempt a vaginal delivery

We sought to assess the relationship between strength of preference for vaginal birth and likelihood of vaginal delivery among women attempting this delivery mode. We conducted a longitudinal study of mode of delivery preferences among women who were <36 weeks' pregnant. Participants completed a sociodemographic and clinical questionnaire and were asked if they preferred vaginal or cesarean delivery. Participants who preferred vaginal delivery completed a standard gamble exercise to assess the strength of this preference on a 0-to-1 scale (higher scores indicate stronger preference for vaginal delivery); those preferring cesarean delivery were assigned a value of 0. Data on clinical characteristics and delivery mode were obtained via telephone interview or chart review. Logistic regression was used to identify predictors of delivery mode among women who attempted a vaginal delivery. Of 210 participants, 156 attempted a vaginal delivery. Their mean and median vaginal delivery preference scores were 0.70 (SD 0.31) and 0.75 (interquartile range, 0.50-0.99), respectively. In multivariate analyses, women with a prior cesarean delivery (adjusted odds ratio [aOR], 0.08; 95% confidence interval [CI], 0.02-0.39) or who delivered an infant ≥4000 g (aOR, 0.04; 95% CI, 0.01-0.28) had significantly lower odds of having a vaginal delivery. After controlling for potential confounders, participants with a stronger preference for vaginal delivery were at significantly higher odds of having a vaginal delivery (aOR, 1.54; 95% CI, 1.01-2.34 for every 0.2 increase on the 0-to-1 scale). Among women who attempt a vaginal delivery, the strength of preference for vaginal birth is predictive of the delivery mode ultimately undergone.

Preventing the First Cesarean Delivery

To the Editor:I read with interest the recent commentary by Spong et al1 and appreciate their investigation of the causes of the rising rate of cesarean delivery. I was surprised, however, at the assertion that labor induction is contributing to this rise: “The overall likelihood of vaginal delivery

Intrapartum Management of Premature Rupture of Membranes

To estimate whether it is possible to define clinically a subgroup of women who have so high a cesarean delivery rate as to avoid spontaneous onset of labor or induced labor. We conducted a retrospective cohort study (October 2005 to January 2010) on a data set of women who had premature rupture of membranes (PROM) at greater than 24 weeks of gestation, a singleton pregnancy, and a viable fetus without congenital anomalies. Patients were treated in a common way regarding indications for delivery. The primary outcome was cesarean delivery. We identified 1,026 women (comprising 7.9% of all deliveries) who had PROM and met the inclusion criteria. There were 404 with preterm deliveries. One hundred thirty-seven (13.4%) had a contraindication to either labor or vaginal delivery. For women with induction (n=355), vaginal delivery occurred in 82%, whereas for those with spontaneous labor (n=534), vaginal delivery occurred in 87% (P=.03). No clinically defined subgroup had an observed cesarean delivery rate greater than 27%, and in most subgroups, it was lower, even when we built in multiple risk factors, including gestational age less than 34 weeks, chorioamnionitis, abruption, and nulliparity. In the absence of a contraindication to labor or to vaginal delivery, the likelihood of vaginal delivery after PROM, with either spontaneous or induced labor, is high, even when we included multiple risk factors for cesarean delivery. II.

The change in the rate of vaginal birth after caesarean section.

The objective of this study was to determine whether, and to what degree, the change in the vaginal birth after caesarean section (VBAC) rate is due to a change in the characteristics of the obstetric population, the undertaking of a trial of labour (TOL), or the tendency to abandon a TOL once it has been initiated. All women with one prior low transverse caesarean section (CS) and a vertex singleton gestation at term were identified in a registry of CS deliveries occurring at eight academic centres during a 4-year period (1999-2002). Women were classified by their predicted chance of VBAC and year-to-year differences were analysed. Of the 9643 women who met criteria for analysis, 5334 (55.3%) underwent a TOL. From 1999 to 2002, the VBAC rate underwent a steady decline: 51.8% to 45.1% to 37.4% to 29.8% (P < 0.001). Although there were some changes in the characteristics of the population that predispose to successful VBAC, as well as some reduction in the chance that a VBAC is successful once a TOL is undertaken, the most pervasive reason for this decline was that women became increasingly likely to forego a TOL, regardless of their likelihood of vaginal delivery. Based on these results, it appears that the change over time in the VBAC rate is multifactorial, although the greatest change has been a decrease in the frequency with which women undertake a TOL, and this change is observed in all categories of the chance of a successful TOL.

Controlled-release dinoprostone vaginal insert for cervical ripening and labor induction

Labor is induced in approximately 20% of pregnancies in Europe and North America. Labor induction in patients with an unfavorable cervix is associated with a higher incidence of prolonged labor and higher rates of operative and cesarean delivery. Prostaglandins used for cervical ripening lead to shorter labor, less use of oxytocin and a greater likelihood of vaginal delivery within 24 h. Dinoprostone (prostaglandin E2) has been used since the 1970’s and is recognized as an agent that not only results in cervical ripening but also activates myometrial contractility. A proprietary sustained- and controlled-release dinoprostone vaginal insert releases a continuous dose of dinoprostone for 12 h and has been shown to decrease the time to vaginal delivery compared with placebo. This controlled-release insert has been compared with various prostaglandin agents and provides safe and efficacious cervical ripening in women with an unfavorable cervix.

Models for the prediction of successful induction of labor based on pre-induction sonographic measurement of cervical length

Objective. To examine the effect of pre-induction cervical length, parity, gestational age at induction, maternal age and body mass index (BMI) on the possibility of successful delivery in women undergoing induction of labor.Methods. In 822 singleton pregnancies, induction of labor was carried out at 35 to 42 + 6 weeks of gestation. The cervical length was measured by transvaginal sonography before induction. The effect of cervical length, parity, gestational age, maternal age and BMI on the interval between induction and vaginal delivery within 24 hours was investigated using Cox's proportional hazard model. The likelihood of vaginal delivery within 24 hours and risk for cesarean section overall and for failure to progress was investigated using logistic regression analysis.Results. Successful vaginal delivery within 24 hours of induction occurred in 530 (64.5%) of the 822 women. Cesarean sections were performed in 161 (19.6%) cases, 70 for fetal distress and 91 for failure to progress. Cox's proportional hazard model indicated that significant prediction of the induction-to-delivery interval was provided by the pre-induction cervical length (HR = 0.89, 95 % CI 0.88–0.90, p < 0.0001), parity (HR = 2.39, 95% CI 1.98–2.88, p < 0.0001), gestational age (HR = 1.13, 95% CI 1.07–1.2, p = < 0.0001) and birth weight percentile (HR = 0.995, 95% CI 0.99 – 0.995, p = 0.001), but not by maternal age or BMI. Logistic regression analysis indicated that significant prediction of the likelihood of vaginal delivery within 24 hours was provided by pre-induction cervical length (OR = 0.86, 95% CI 0.84–0.88, p < 0.0001), parity (OR = 3.59, 95% CI 2.47–5.22, p < 0.0001) and gestational age (OR = 1.19, 95% CI 1.07–1.32, p = < 0.0001) but not by BMI or maternal age. The risk of cesarean section overall was significantly associated with all the variables under consideration, i.e., pre-induction cervical length (OR = 1.09, 95% CI 1.06–1.11, p < 0.0001), parity (OR = 0.25, 95% CI 0.17–0.38, p < 0.0001), BMI (OR = 1.85, 95% CI 1.24–2.74, p = 0.0024), gestational age (OR = 0.88, 95% CI 0.78–0.98, p = 0.0215) and maternal age (OR = 1.04, 95% CI 1.01–1.07, p = 0.0192). The risk of cesarean section for failure to progress was also significantly associated with pre-induction cervical length (OR = 1.11, 95% CI 1.07–1.14, p < 0.0001), parity (OR = 0.26, 95% CI 0.15–0.43, p < 0.0001), gestational age (OR = 0.83, 95% CI 0.73–0.96, p = 0.0097) and BMI (OR = 2.07, 95% CI 1.27–3.37, p = 0.0036).Conclusion. In women undergoing induction of labor, pre-induction cervical length, parity, gestational age at induction, maternal age and BMI have a significant effect on the interval between induction and delivery within 24 hours, likelihood of vaginal delivery within 24 hours and the risk of cesarean section.

The value of ultrasound in the prediction of successful induction of labor.

To examine the value of pre-induction sonographic assessment of cervical length, posterior cervical angle and occipital position in the prediction of the induction-to-delivery interval within 24 h, the likelihood of vaginal delivery within 24 h, the likelihood of Cesarean section and to compare sonographic assessment with the Bishop score. In 604 singleton pregnancies, induction of labor was carried out at 35-42 weeks of gestation. Immediately before induction, transvaginal sonography was performed for measurement of cervical length and posterior cervical angle and a transabdominal scan was carried out to determine the position of the fetal occiput. The value of occipital position, posterior cervical angle, cervical length, parity, gestational age, maternal age, and body mass index (BMI) on the induction-to-delivery interval within 24 h, the likelihood of vaginal delivery within 24 h and the likelihood of Cesarean section were investigated by Cox proportional hazard model or logistic regression analysis. Vaginal delivery occurred in 484 (80.1%) women and this was within 24 h of induction in 388 (64.2%). Cesarean section was performed in 120 (19.9%). Occiput-anterior (OA) and transverse (OT) positions were analyzed as one group as the odds ratios (OR) and the HR were similar and different from occiput-posterior (OP), which was analyzed as another group. Prediction of the induction-to-delivery interval was provided by the occipital position, pre-induction cervical length, parity and posterior cervical angle. Prediction of the likelihood of vaginal delivery within 24 h was provided by the occipital position, cervical length, posterior cervical angle and BMI. Prediction of the likelihood of Cesarean section was provided by the occipital position, cervical length, parity, maternal age and BMI. In the prediction of vaginal delivery within 24 h, for a specificity of 75%, the sensitivity for ultrasound findings was 89% and for the Bishop score it was 65%. The respective sensitivities for Cesarean section were 78% and 53%. In women undergoing induction of labor, significant independent prediction of the induction-to-delivery interval within 24 h, the likelihood of vaginal delivery within 24 h and the likelihood of Cesarean section are provided by pre-induction cervical length, occipital position, posterior cervical angle and maternal characteristics. Sonographic parameters were superior to the Bishop score in the prediction of the outcome of induction.

Pre-induction sonographic measurement of cervical length in prolonged pregnancy: the effect of parity in the prediction of induction-to-delivery interval.

To examine the effect of parity on the relationship between pre-induction cervical length and the induction-to-delivery interval and rate of vaginal delivery within 24 h in women undergoing induction of labor for prolonged pregnancy. In 382 singleton pregnancies, induction of labor was carried out at 41 + 3 to 42 + 1 weeks of gestation. The cervical length was measured by transvaginal sonography before induction. Univariate analyses were performed by constructing Kaplan-Meier survival curves for the induction-to-delivery interval for various subgroups, and comparing these using log rank tests. Multivariate analyses were performed using the Cox proportional hazards model and multiple linear regression. Successful vaginal delivery within 24 h of induction occurred in 67% of the women and the pre-induction cervical length was significantly associated with the induction-to-delivery interval and the rate of vaginal delivery within 24 h. Sonographically measured cervical length was better than the Bishop score or cervical length by vaginal examination in predicting the outcome of induction. Parity provided a significant independent contribution, in addition to pre-induction cervical length, in the prediction of the outcome of labor. Thus, in multiparae the incidence of successful vaginal delivery within 24 h of induction was about 30% higher than in nulliparae. For the same cervical length, the induction-to-delivery interval in multiparae was 37% lower than in nulliparae. In women undergoing induction of labor for prolonged pregnancy, cervical length and parity provide independent prediction of induction-to-delivery interval and the likelihood of vaginal delivery within 24 h of induction.

Term and preterm induction of labour for pregnancy-induced hypertension

Pregnancy-induced hypertension (PIH) is a common and potentially serious condition. Early delivery is often necessary. This study investigates the influence of gestational age and parity on the likelihood of vaginal delivery following labour induction in a UK district hospital maternity unit. The casenotes of 185 consecutive inductions for PIH between January 1997 and September 2000 were studied. Women with chronic hypertension, diabetes, multiple pregnancies or fetal death before labour were excluded. Gestational age varied between 31 and 42 weeks. Seventy-two per cent of the mothers were nulliparous; 58% had gestational hypertension (i.e. hypertension without proteinuria) and 42% had pre-eclampsia (i.e. hypertension with proteinuria). Vaginal delivery rates for nulliparous mothers with gestational hypertension were 50% at 34–36 weeks and 78% at 37–42 weeks; for those with pre-eclampsia rates were 0% at 31–33 weeks, 85% at 34–36 weeks and 78% at 37–42 weeks. Vaginal delivery rates for multiparous mothers with gestational hypertension were 100% at 31–36 weeks and 92% at 37–42 weeks; those with pre-eclampsia had a rate of 100% at all gestations.

Transvaginal ultrasonographic cervical measurement as a predictor of successful labor induction

Our purpose was to compare transvaginal cervical measurement and the Bishop score as indicators of duration of labor and successful induction of labor at term. This prospective observational study recruited women with singleton gestations scheduled for induction of labor at > or =37 weeks. Transvaginal ultrasonographic measurement of cervical length was performed and the Bishop score was determined, each by operators masked to the other measurement. Data were collected on parity, gestational age, mode of delivery, induction agent, induction-to-delivery interval, Bishop score, and cervical length measurement. A total of 77 women were analyzed. Vaginal delivery occurred in 69%. Both Bishop score and cervical length showed linear correlation with duration of labor (R(2) = 0.43, P <. 001; R(2) = 0.48, P <.001; respectively). Women with cervical length <3.0 cm had shorter labors (P <.001) and were more likely to be delivered vaginally (P <.001). Women with a Bishop score >4 also had shorter labors and were more likely to be delivered vaginally, with similar P values. A logistic regression model identified cervical length and parity as the only independent predictors of vaginal delivery. Both ultrasonographically measured cervical length and Bishop score predict duration of labor and likelihood of vaginal delivery. However, only cervical length and parity were independent predictors of mode of delivery.