Prediction Of Successful Labor Induction Research Articles

Comparison of sonographic score and Bishop score in the prediction of successful labor induction in term patients: A prospective observational study

BackgroundThe cervical favorability for IOL is assessed by scoring systems. There are various scoring systems, including the Field system, Lange pelvic scoring system, and Bishop scoring system, which was then modified and termed ‘The modified Bishop scoring system, and it is the most widely used one. This scoring is done based on the assessment of the station of the fetal presenting part, consistency, position, dilatation, and length of the maternal cervix. Owing to its subjective assessment, there is a high chance of inter-observer variability. Therefore, radiological methods such as Trans-vaginal ultrasonogram (TVS) and Trans-abdominal ultrasonogram (TAS) are preferred over manual methods. This study aims to determine the role of assessment of the cervix by Modified Bishop Score and assessment of the cervical parameters by Transvaginal ultrasonogram (TVS) and compare them in predicting the outcome of labour. Material and methodsThis prospective observational study was conducted by the Department of Obstetrics and Gynecology in a tertiary care hospital located at Chengalpattu, Tamil Nadu, in a term singleton pregnancy woman, and the Study period was from January 2023 to July 2023 for six months. In total, one hundred fifty pregnant women were recruited. The study inclusion criteria were singleton pregnant women with intact amniotic membranes and a period of gestation >37 weeks with cephalic presentation. The findings of TVS were blinded to the person who measured cervical parameters for the bishop score. IOL done for both favorable and unfavorable cervix according to the guidelines given by FOGSI-ICOG (2018) for IOL. ResultsReceiver operating characteristic (ROC) curve analysis showed the area under the curve (AUC) for the TVS score was 0.705(95 % CI: 0.616–0.794) against the standard bishop score. TVS Score≥6.5 cm is the best cut-off value to ascertain successful IOL with a sensitivity of 99 % and specificity of 94 % among singleton pregnancy women. ConclusionThis prospective observational study deduced that TVS scoring is a valid alternative tool against the standard bishop score in predicting cervical favorability for IOL among singleton pregnant women with plausible sensitivity and specificity. TVS scoring for assessing cervical favorability acts as an outstanding marker in predicting the IOL with a cut-off value of ≥6.5 cm in singleton pregnant women.

Diagnostic accuracy of posterior cervical angle, and cervical length in Prediction of Successful labor induction

Objective: To study the evaluation of the value of the posterior cervical angle, and cervical length, measured by transvaginal ultrasonography, compared with the Bishop Score in the prediction of successful labor induction.

Cervical Length and Posterior Cervical Angle measured by Transvaginal US as Alternative to Bishop Score in Prediction of Successful Labor Induction

Cervical Length and Posterior Cervical Angle measured by Transvaginal US as Alternative to Bishop Score in Prediction of Successful Labor Induction

Comparison of transvaginal cervical length and modified Bishop’s score as predictors for labor induction in nulliparous women

Objective: To compare the transvaginal cervical length (TVCL) to the modified Bishop’s score for prediction of successful labor induction in nulliparous women. Methods: A total of 210 nulliparous women who were diagnosed as premature rupture of membranes were recruited in this comparative prospective study, which was carried out in the Obstetrics and Gynecology Department of Ain Shams University, Egypt over two years for labor induction. The studied women were examined by trans-vaginal ultrasound for measurement of the cervical length (CL) and vaginally to calculate the modified Bishop’s score, followed by induction of labor. Collected data were analyzed to compare the TVCL to the modified Bishop’s score for prediction of successful labor induction in nulliparous women. The success of induction process was defined as vaginal birth after the induction of labor. Results: One hundred and forty-three women of studied women had CL 4; 128 of them delivered vaginally (P=0.006). The CL 4 than women with Bishop’s score of ≤4 (P=0.01; 95% confidence interval: 1.6-4.5). Conclusions: Both TVCL and the modified Bishop’s score are complementary tools in pre-induction cervical assessment before induction of labor, while the TVCL at <28 mm is significantly more specific with more positive predictive value as predictor of successful induction than the modified Bishop’s score.

Measures of success: Prediction of successful labor induction

Ideally, all pregnant women would enter labor spontaneously at the safest time to yield the best health outcomes for both themselves and their newborns. Unfortunately, this does not always happen and leaves obstetric providers weighing the maternal and fetal risks of continued expectant management versus labor induction. Several elements have been reported to affect the success rate of an induction, including the Bishop score, maternal parity, body mass index (BMI), age, medical comorbidities, fetal gestational age, and estimated weight, as well as the hospital site and provider practice. Recent data suggest that the decision to induce or continue expectant management in anticipation of labor is an important variable in determining whether a woman has a safe and successful delivery.

Can measurement of cervical length, fetal head position and posterior cervical angle be an alternative method to Bishop score in the prediction of successful labor induction?*

Aim: The purpose of this study was to evaluate sonographic cervical length, posterior cervical angle and fetal head position in predicting successful induction of labor at term can be an alternative method to Bishop score. Methods: This prospective observational study recruited 223 women with singleton gestations scheduled for induction of labor at 37–42 weeks. Parity, body mass index, Bishop score, fetal head position, cervical angle measurement and cervical length was investigated to predict successful labor induction. Multiple regression analysis was performed to determine the parameters in the prediction of successful vaginal delivery within 24 hours. Results: Forty-five patients were excluded because of cesarean section performed for other reasons than arrest of dilation or fetal head descent (43 fetal distress, 2 cord prolapsus). Remaining 178 patients were divided into two groups according to duration of delivery time. 139 patients delivered within 24 hours were classified as group I, 39 patients delivered after 24 hours were classified as group II. Percentage of multiparity was statistically significantly higher in group I than in group II [59 (42.4%), 9 (23.0%) respectively, p = 0.009]. Cervical length was statistically significantly shorter in group I than in group II [23.1 ± 7.42 mm, 31.3 ± 6.83 mm respectively, p < 0.001]. Bishop score was statistically significantly higher in group I than in group II [3 (1–4), 1 (1–4) respectively, p < 0.001]. Posterior cervical angle was statistically significantly higher in group I than in group II [100.1 ± 17.2, 92.7 ± 21.4 respectively, p = 0.007]. According to the fetal head position, there was no statistically significant difference in labor duration between the groups (p = 0.787). In the multivariate regression analysis of variables, multiparity, cervical length and Bishop score were statistically significantly predictive in successful labor induction. Conclusion: Multiparity status, cervical length, posterior cervical angle and Bishop score can predict successful labor induction, but fetal head position is not predictive in successful labor induction.

Quantitative Elastography of the Cervix for Predicting Labor Induction Success

To evaluate the role of quantitative elastography of the cervix in the prediction of successful labor induction compared to the Bishop score (BS) and ultrasound cervical length (CL). A prospective pilot study was conducted between July 2010 and June 2011 in patients without preterm membrane rupture undergoing labor induction with vaginal prostaglandins. Before starting induction, the BS, functional CL and cervical tissue strain (TS) were assessed. TS assessment was performed twice using the Tissue Doppler Imaging (TDI) software. Diagnostic accuracy was evaluated for the prediction of the following endpoints: active labor achievement (success vs. failure, time interval < 24 h and < 48 h), vaginal delivery (success vs. failure, time interval < 36 h and < 72 h) and total amount of prostaglandins used for labor induction (< 6 mg and < 12 mg). We analyzed 77 patients with a mean gestational age of 39.7 ± 1.5 weeks of gestation and a mean strain of 0.75 ± 0.17. The TS significantly predicted a failure of labor induction, which occurred in 4 cases, both in mono- and multivariate analysis, independently of the functional cervical length (TS 0.6 ± 0.1). No correlation was found between the TS and other outcomes. The Bishop score and functional cervical length were found to predict only an early response to labor induction (time to active labor < 24 h, time to vaginal delivery < 36 h and PG usage < 6 mg). The diagnostic accuracy was slightly but not significantly improved if both TS and CL were considered. Preliminary data show the possible usefulness of quantitative cervical elastography in the prediction of labor induction failure.

Prediction of successful labor induction using transvaginal sonographic cervical measurements

To predict the success of labor induction by sonographic cervical measurements, maternal/obstetrical factors, and the Bishop's score. Between February 2008 and February 2010, 190 consecutive pregnant women underwent clinical examination to assess the Bishop's score and transvaginal sonographic cervical measurements (cervical length, fetal head stage, and cervical dilatation) before labor induction. The following outcomes were analyzed: overall vaginal delivery and vaginal delivery up to 24 hours after labor induction. Overall vaginal delivery occurred in 133 (70.0%) patients and vaginal delivery 24 hours after labor induction happened in 119 (62.6%) patients. The sonographic cervical measurements were significantly associated with all outcomes (p < 0.01). The areas under the ROC curve (AUC) of all ultrasound cervical parameters to predict the two events were 68.9% and 72.0% (cervical length); 71.6% and 73.6% (fetal head stage); and 72.0% and 73.4% (cervical dilatation). Mathematical equations were obtained to calculate the probability for each event considering the sonographic cervical measurements in association with clinical factors after regression analysis, which increased the AUC for both events (80.1% and 79.3%). Transvaginal sonographic cervical measurements can predict the successful labor induction, especially when associated to clinical analysis (Bishop's score).

Clinical parameters for prediction of successful labor induction after application of intravaginal dinoprostone in nulliparous Chinese women.

SummaryBackgroundThe aim of this study was to compare the possible clinical parameters for prediction of successful labor induction in Chinese nulliparous women.Material/MethodsA retrospective, observational trial of labor induction was performed, using a single dose of 10 mg controlled-release dinoprostone for preinduction cervical ripening in 127 nulliparous women (gestational age 38–42 weeks, singleton cephalic presentation). The characteristics of the women with successful labor induction (defined as vaginal delivery achieved on the day of admission; n=80) and failed labor induction (n=47) were compared.ResultsThe main differences observed between the groups were gravidity (P<0.05), induction-active labor interval (5.16±2.98 vs. 8.40±3.41; P<0.05) and birth weight (3421.11±368.14 vs. 3566.36±345.16; P<0.05). Logistic regression demonstrated that gravidity (P<0.05) and induction-active labor interval (P<0.05), but not Bishop score, were significant and independent contributing factors for successful labor induction. In the receiver operating characteristic curves for the prediction of successful labor induction, the best cut-off value for gravidity was 3 (95% confidence interval [CI] 0.64–0.83, P=0.000), and the best cut-off value for the induction-active labor interval was 7.96 (95%CI 0.66–0.85, P=0.000).ConclusionsLess gravidity and shorter induction-active labor interval predict successful labor induction with reasonable accuracy.

Prediction of successful labor induction by evaluation of maternal symptoms at an early stage of the misoprostol induction protocol

This prospective observational study evaluated maternal symptoms and characteristics that predict successful labor induction with oral misoprostol. A total of 244 consecutive women undergoing labor induction voluntarily completed a questionnaire about subjective sensations and pain scores during the induction protocol. Maternal and neonatal characteristics were collected retrospectively from patient files. On the first day of induction, oral misoprostol (50 μg) every 4 h up to three doses was used. A total of 46% of the parturients delivered or reached the active phase of labor 24 h after the initial dose of misoprostol (ID). In the whole study, 87% of the women delivered vaginally. In multivariable analysis, rupture of membranes, cervical dilatation before the initial dose, maternal sensation of painful contractions at 8 h after the initial dose, and gestational age, were found to be associated with successful labor induction. Maternal sensation of painful contractions 8 h after an ID is an independent predictive factor of successful labor induction (defined as delivery or active phase of labor 24 h after beginning of induction). Other independent predictive factors are rupture of membranes, cervical dilatation before the initial dose, and gestational age.

Digital and Transvaginal Ultrasound Cervical Assessment for Prediction of Successful Labor Induction

Abstract Objective To compare the values of preinduction transvaginal cervical length measurements and Bishop score to predict successful labor induction. Methods A prospective, observational trial of nulliparous women undergoing labor induction. Inclusion criteria were gestational age between 36 and 42 weeks, singleton cephalic presentation of the fetus, and intact membranes. Preinduction cervical ripening was performed using 25 μg intravaginal misoprostol (PGE1), repeated every 4 h, up to a maximum of 3 doses. Induction was subsequently continued by oxytocin and amniotomy. Results A total of 43 women met the inclusion criteria. Mean preinduction cervical length for women with successful or failed labor induction was 26 mm (95% Confidence interval [CI], 27–32) and 34 mm (95% CI, 33–38), respectively ( P = 0.002). Mean Bishop scores for successful and failed induction groups were 5.4 (95% CI, 5.2–6.2) and 3.1 (95% CI, 2.8–3.5), respectively ( P = 0.003). Conclusion Digital examination and transvaginal ultrasound of the cervix predict successful labor induction with reasonable accuracy.

OP23.03: Bishop score, cervical length and fetal fibronectin immunoassay in prediction of successful labor induction in hypertensive disorders of pregnancy

OP23.03: Bishop score, cervical length and fetal fibronectin immunoassay in prediction of successful labor induction in hypertensive disorders of pregnancy

Digital and transvaginal ultrasound cervical assessment for prediction of successful labor induction

Objective To compare the values of preinduction transvaginal cervical length measurements and Bishop score to predict successful labor induction. Methods A prospective, observational trial of nulliparous women undergoing labor induction. Inclusion criteria were gestational age between 36 and 42 weeks, singleton cephalic presentation of the fetus, and intact membranes. Preinduction cervical ripening was performed using 25 μg intravaginal misoprostol (PGE1), repeated every 4 h, up to a maximum of 3 doses. Induction was subsequently continued by oxytocin and amniotomy. Results A total of 43 women met the inclusion criteria. Mean preinduction cervical length for women with successful or failed labor induction was 26 mm (95% Confidence interval [CI], 27–32) and 34 mm (95% CI, 33–38), respectively ( P = 0.002). Mean Bishop scores for successful and failed induction groups were 5.4 (95% CI, 5.2–6.2) and 3.1 (95% CI, 2.8–3.5), respectively ( P = 0.003). Conclusion Digital examination and transvaginal ultrasound of the cervix predict successful labor induction with reasonable accuracy.

OP22.04: Prediction of successful labor induction in twin gestation: body mass index, digital examination, and sonographic measurement of cervical length

The purpose of this study was to evaluate the predictive value of body mass index (BMI), Bishop score, and the sonographic measurement of cervical length for predicting successful labor induction (defined as an ability to achieve the active phase of labor within 1 day after induction) in twin gestations. This prospective observational study enrolled 50 consecutive women with twin pregnancy at more than 34.0 weeks of gestation scheduled for induction of labor. Transvaginal ultrasound for measurement of cervical length was performed and the Bishop score was assessed by digital examination. Univariate and multivariate analyses were used for statistical analysis. Labor induction was successful in 52% (26/50). Women who had successfully induced labor revealed significantly lower BMI and a lower rate of Cesarean delivery than those who failed to induce labor. However, no significant differences were found regarding median gestational age at the time of labor induction, median cervical length, median Bishop score, distribution of parous and nonparous women, the prevalence of prostaglandin use, and the median birth weight between these two patient groups. To predict the success of labor induction, the best cut-off value of BMI was 29, with a sensitivity of 77% and a specificity of 62%, respectively. Multiple logistic regression demonstrated that only BMI provided a significant contribution to predicting successful labor induction. The BMI independently predicted the success of labor induction in twin gestation. However, sonographic measurement of cervical length and Bishop score appeared to have poor predictive value for the likelihood of successful induction.

Fetal fibronectin as a predictor of term labor: A literature review

Accurately predicting the onset of delivery continues to be problematic notwithstanding the clinical relevance of this capability, especially with regard to the elective induction of labor. While the assessment of the cervix according to Bishop, to date, constitutes the single generally recognized method, the determination of fetal fibronectin (FFN) cervicovaginal secretions promises greater precision in this context.English-language medical literature was analyzed using the search parameter 'fetal fibronectin', 'term delivery', 'induction of labor', 'labor', and 'birth', respectively. All those original reports examining cervicovaginal FFN that were originally published in English and followed a prospective design were subsequently included in the study at hand. These reports were evaluated in regard to their findings on the predictive value of FFN for spontaneous delivery and induction of labor.A total of eight reports were included in the present study: five of these, covering a total of 480 patients, discussed the relationship between FFN and the spontaneous onset of labor; the other three addressed the subject of FFN and the induction of labor (300 patients). All reports clearly related the presence of FFN in cervicovaginal secretions to the imminent onset of delivery; three studies, furthermore, demonstrated a correlation with the spontaneous onset of labor, with a sensitivity greater than 90%. In case of the studies concerning induction of labor, a positive FFN result was accompanied by a significantly shorter interval until delivery than a negative FFN result.Determining the presence of FFN in cervicovaginal secretions promises to provide an indicator relating to the prediction of term labor, as well as to the prediction of successful labor induction.

Fetal fibronectin as a predictor of term labor:

Accurately predicting the onset of delivery continues to be problematic notwithstanding the clinical relevance of this capability, especially with regard to the elective induction of labor. While the assessment of the cervix according to Bishop, to date, constitutes the single generally recognized method, the determination of fetal fibronectin (FFN) cervicovaginal secretions promises greater precision in this context. English-language medical literature was analyzed using the search parameter 'fetal fibronectin', 'term delivery', 'induction of labor', 'labor', and 'birth', respectively. All those original reports examining cervicovaginal FFN that were originally published in English and followed a prospective design were subsequently included in the study at hand. These reports were evaluated in regard to their findings on the predictive value of FFN for spontaneous delivery and induction of labor. A total of eight reports were included in the present study: five of these, covering a total of 480 patients, discussed the relationship between FFN and the spontaneous onset of labor; the other three addressed the subject of FFN and the induction of labor (300 patients). All reports clearly related the presence of FFN in cervicovaginal secretions to the imminent onset of delivery; three studies, furthermore, demonstrated a correlation with the spontaneous onset of labor, with a sensitivity greater than 90%. In case of the studies concerning induction of labor, a positive FFN result was accompanied by a significantly shorter interval until delivery than a negative FFN result. Determining the presence of FFN in cervicovaginal secretions promises to provide an indicator relating to the prediction of term labor, as well as to the prediction of successful labor induction.