Predictors Of Vaginal Delivery Research Articles

Comparison of outcomes of labor induction with dinoprostone vaginal insert (PROPESS) and double balloon cook catheter in term nulliparous pregnancies.

This retrospective study aimed to compare the outcomes of dinoprostone vaginal insert (PROPESS) and double balloon cook catheter (DBC) in term nulliparous pregnancies. A total of 1682 cases were enrolled, all of which were divided into two groups: PROPESS and DBC. The primary outcomes were rate of vaginal delivery (VD) and cesarean section (CS) and successful VD within 24 h and CS indications; the secondary outcomes were labor duration, oxytocin augmentation, complications during labor, maternal/neonatal outcomes, and predictors of successful VD within 24 h. There was no statistical difference in the rates of VD between the PROPESS group (73.74%) and the DBC group (77.73%) (p = 0.36). The VD rate within 24 h was significantly higher in PROPESS group than in the DBC group (55.45% vs. 38.43%, p < 0.001). The occurrence of nonreassuring fetal heart rate (NRFHR) patterns was higher in the CS indications of the PROPESS group than in the DBC group (56.86% vs. 37.81%, p < 0.001). The oxytocin augmentation was significantly lower in the PROPESS group than in the DBC group (52.79% vs. 94.9%, p < 0.001). The incidence of chorioamnionitis was significantly higher in the DBC group as compared with PROPESS group (4.36% vs. 1.34%, p < 0.001), while neonatal outcomes were comparable between the two groups. PROPESS (p < 0.001, odds ratio [OR] 2.478, 95% confidence interval [CI] 1.718-3.574), oxytocin augmentation (p < 0.001, OR 32.759, 95% CI 20.654-51.958), and amniotomy (p = 0.016, OR 1.897, 95% CI 1.331-2.704) were predictors of VD within 24 h. The effectiveness of delivery was comparable between the two groups. The PROPESS group resulted in a high successful VD rate within 24 h, although accompanied by NRFHR occurrence. Two cases with fetal presentation change (cephalic to breech) and four cases with umbilical cord prolapse were observed in the DBC group. PROPESS, oxytocin augmentation, and amniotomy were associated with VD interval within 24 h.

Comparison by Mode of Delivery of Preterm Pregnancy Inductions with Cervical Ripening Balloon: A Retrospective Chart Review

Background: Preterm inductions may be necessary for maternal comorbidities or fetal abnormalities. Previous studies have identified risk factors for undergoing a cesarean delivery (CD). Our study examined the insertion-to-expulsion time (IET) of cervical ripening balloons (CRB) in preterm inductions that achieved vaginal delivery (VD) compared to CD. Methods: This was a retrospective cohort study of preterm inductions with CRB between 2010 and 2021. Primary outcome was IET of CRB. IRB approval was obtained. Results: The study included 82 women. IET for cesarean patients was significantly greater, and required more removal of CRB at the allotted 12 h. Dilation before and after CRB was significantly greater in the vaginal cohort. There was no significant difference in maternal comorbidities, indication for induction or neonatal complications. Conclusions: Maternal comorbidities, induction indication and neonatal complications were similar between cohorts, making trial of induction with CRB in preterm women a reasonable option. Spontaneous expulsion of CRB and greater dilation may be predictors of vaginal delivery.

Predictors of Vaginal Delivery among Patients Admitted with Severe Preeclampsia.

This study aimed to assess the rates of vaginal delivery (VD) and the predictors of VD in a cohort of patients with early (<34 weeks) preeclampsia with severe features (Early Severe PreEClampsia [ESPEC]). We conducted a retrospective cohort study of patients with ESPEC admitted to a single center from 2013 to 2019. Exclusion criteria included patients with contraindications to labor, multifetal gestation, or presenting in spontaneous labor. Patient characteristics were abstracted. The primary outcome was rate of VD. Secondary outcome was factors associated with VD. Secondary analysis performed including only primiparous patients. Bivariate statistics and logistic regression were used to analyze data. Of 229 patients with ESPEC, 184 (80%) were candidates for labor. Of those, 74 (40%) underwent prelabor cesarean delivery (CD). Among the 110 remaining patients who attempted VD, 47 (43%) were successful. No significant differences in characteristics between VD and CD patients were found on bivariate analysis. In regression models, BMI ≥ 40 was associated with increased odds of CD (adjusted odds ratio [aOR]: 2.83, 95% confidence interval [CI]: 1.01, 7.95), whereas private insurance was associated with reduced odds of CD (aOR: 0.37, 95% CI: 0.16, 0.86). In planned secondary analysis of primiparous patients, 101/123 (82%) were candidates for labor. Of those, 29 underwent prelabor CD. The VD rate among primiparous patients attempting labor was 40% (29/72). In this subgroup, private insurance was associated with VD (71 vs. 46%, p = 0.03). In regression models, only private insurance remained associated with CD (aOR: 0.30, 95% CI: 0.10, 0.92). Patients with ESPEC who attempted VD were successful less than half of the time, with similar rates among the subset of primiparous patients. BMI ≥ 40 was associated with increased odds of CD, whereas private insurance was associated with reduced odds of CD. These data may aid providers in counseling patients with ESPEC on the likelihood of successful VD. · Only 43% of ESPEC patients who attempted VD were successful.. · Subset of primiparous patients w/ESPEC had similar VD rate.. · BMI ≥40 kg/m2 in ESPEC patients was associated with increased odds of CD..

Influence of muscle variables on delivery route after perineal preparation in primiparous women

Introduction: Many pregnant women seek vaginal delivery, as a healthier and more respectful mode of delivery, and perineal massage and instrument-assisted perineal stretching techniques aim to bring better postpartum outcomes. Despite this, some deliveries may not occur as expected and conclude with interventions or surgical delivery. Objective: To analyze the influence of muscle variables on the mode of delivery of women undergoing perineal preparation. Methods: This is a secondary analysis of a clinical trial in which primiparous women with a gestational age of 33 weeks were included. Evaluations were performed before and after eight intervention sessions using perineal massage and stretching assisted by the Epi-No Delphine Plus® instrument. Perineal distensibility muscle variables were evaluated using the Epi-No Delphine Plus® equipment and the peak and mean strength of pelvic floor muscles (PFM) using the PeritronTM vaginal manometer. After delivery, the method of delivery performed was determined by telephone contact. For statistical analysis, univariate logistic regression was performed with a significance level of 0.05. Results: Sixty-one primiparous women were included in the study (mean age: 30 years; SD: 4.8). None of the muscle variables examined were predictors for vaginal delivery (p &gt; 0.05). Conclusion: Muscle variables did not influence the final delivery route of women undergoing perineal preparation.

Predictive Factors for Successful Cervical Ripening among Women with Gestational Diabetes Mellitus at Term: A Prospective Study.

The purpose of this prospective cohort study is to identify the predictive factors for vaginal delivery among women (n = 146) who underwent cervical ripening using a dinoprostone insert (PG) alone (13.7%), cervical ripening balloon (CRB) alone (52.7%), oral misoprostol (M) alone (4.1%), or repeated methods (R, 29.5%) for gestational diabetes mellitus (GDM) at term, and to analyze maternal and neonatal morbidity outcomes according to the method for cervical ripening. After cervical ripening, vaginal delivery occurred in 84.2% (n = 123) and was similar among groups (90.0% after PG, 83.1% after CRB, 83.3% after M, and 83.7% after R; p = 0.89). After a multivariable logistic regression analysis adjusted for potential confounders, the internal cervical os being open before cervical ripening was a predictor of vaginal delivery (adjusted odds ratio (OR) of 4.38, 95% confidence index (CI) of 1.62-13.3, p = 0.03), and previous cesarean delivery was a predictor of cesarean delivery (aOR of 7.67, 95% CI of 2.49-24.00, p < 0.01). Birthweight was also significantly associated with cesarean delivery (aOR of 1.15, 95% CI of 1.03-1.31, p = 0.02). The rates of maternal and neonatal morbidity outcomes were 10.9% (n = 16) and 19.9% (n = 29), respectively, and did not differ according to the mode of delivery and to the method used for cervical ripening. Identifying these specific high-risk women (previous cesarean delivery and internal cervical os being closed before cervical ripening) for cesarean delivery among women who underwent cervical ripening for GDM at term is important and practical for all physicians to make a decision in partnership with women.

Predictors of vaginal delivery following balloon catheter for labor induction in women with one previous cesarean

BackgroundThe aim of this study was to estimate predictors for vaginal birth following balloon catheter induction of labor (IOL) in women with one previous cesarean section (CS) and an unfavorable cervix.MethodsThis 4-year retrospective cohort study was conducted in Longhua District Central Hospital in Shenzhen China, between January 2015 and December 2018. Patients with one previous CS and a current singleton-term pregnancy who underwent balloon catheter cervical ripening and IOL were enrolled. Univariate analysis was used to identify predictive factors associated with vaginal birth after cesarean section (VBAC). Binary logistic regression was further used to identify which factors were independently associated with the outcome measure. The primary outcome was VBAC, which was a successful trial of labor after cesarean delivery (TOLAC) following IOL.ResultsA total of 69.57% (208/299) of the women who planned for IOL had VBAC. In the final binary logistic regression equation, lower fetal weight (< 4000 g) (odds ratio [OR]5.26; 95% confidence interval [CI] 2.09,13.27), lower body mass index (BMI,<30 kg/m2) (OR 2.27; CI 1.21, 4.26), Bishop score after cervical ripening > 6 (OR 1.94; CI 1.37, 2.76) remained independently associated with an increased chance of VBAC.ConclusionsThe influencing factors of VBAC following IOL were fetal weight, BMI, and Bishop score after cervical ripening. Adequate individualized management and assessment of the IOL may help improve the VBAC rate.

Fetal Head–Perineum Distance on Transperineal Ultrasound as Predictor of Vaginal Delivery in Term Nulliparous Women Undergoing Induction of Labor

Fetal Head–Perineum Distance on Transperineal Ultrasound as Predictor of Vaginal Delivery in Term Nulliparous Women Undergoing Induction of Labor

Predictors of vaginal delivery in women with body mass index 60 kg/m2 or greater

Though women with body mass index (BMI) 60 kg/m2 or greater are at an increased risk of cesarean delivery, predictors of vaginal delivery in this group is not well known. We sought to examine predictors of vaginal delivery in women with BMI 60 kg/m2 or greater.

The Value of Posterior Cervical Angle as a Predictor of Vaginal Delivery: A Preliminary Study.

Accurate prediction of failure to progress and rapid decision making regarding the mode of delivery can improve pregnancy outcomes. We examined the value of sonographic cervical markers in the prediction of successful vaginal delivery beyond 34 weeks of gestation. A retrospective chart review was carried out. Medical information of singleton gestations delivered at a single center from 1 July 2019 to 30 August 2020 was collected. Transvaginal sonographic records of cervical length, anterior and posterior cervical angles, and cervical dilatation were obtained and re-measured. The value of these markers and clinical characteristics of mother and baby on vaginal delivery were investigated and compared to women who underwent cesarean section. A total of 90 women met the inclusion criteria. The rate of vaginal delivery was 75.6%. There were no differences found in terms of maternal age, rate of abortion, induction of labor, premature rupture of membranes, preterm labor, hypertension, diabetes, cervical length, and neonatal sex and weight. The prediction of vaginal delivery was provided by parity, maternal body mass index, and posterior cervical angle. The area under the receiver operating characteristic curve for prediction of vaginal delivery was 0.667 (95% CI 0.581–0.864, p = 0.017) for the posterior cervical angle, with a cutoff of 96.5°. Regression analysis revealed a posterior cervical angle ≥96.5° in the prediction of vaginal delivery (adjusted odds ratio: 6.24; 95% confidence interval: 1.925–20.230, p = 0.002). Posterior cervical angle ≥96.5° is associated with successful vaginal delivery. It is simple and easy to measure and can be useful in determining the mode of delivery.

Clinical predictive factors for vaginal delivery following induction of labour among pregnant women in Jordan

BackgroundInduction of labour (IOL) is an important and common clinical procedure in obstetrics. In the current study, we evaluate predictors of vaginal delivery in both nulliparous and multiparous women in north Jordan who were induced with vaginal prostaglandins.MethodA prospective study was conducted on 530 pregnant women at King Abdullah University Hospital (KAUH) in north Jordan. All pregnant mothers with singleton live fetuses, who had induction of labour (IOL) between July 2017 and June 2019, were included in the study. Mode of delivery, whether vaginal or caesarean, was the primary outcome. Several maternal and fetal variables were investigated. The safety and benefit of repeated dosage of vaginal prostaglandin E2 (PGE2) tablets, neonatal outcomes and factors that affect duration of labour were also evaluated.Pearson χ2 test was used to investigate the significance of association between categorical variables, while student’s t-test and ANOVA were applied to examine the mean differences between categorical and numerical variables. Linear regression analysis was utilized to study the relation between two continuous variables. A multivariate regression analysis was then performed. Significance level was considered at alpha less than 0.05.ResultsNulliparous women (N = 254) had significantly higher cesarean delivery rate (58.7% vs. 17.8%, p < 0.001) and longer duration of labour (16.1 ± 0.74 h vs. 11.0 ± 0.43 h, p < 0.001) than multiparous women (N = 276). In nulliparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop score; the mean Bishop score was 3.47 ± 0.12 in nulliparous women who had vaginal delivery vs. 3.06 ± 0.10 in women who had cesarean delivery (Adjusted odds ratio (AOR) = 1.2, 95% CI: 1.03–1.28, p = 0.03). In multiparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop scores and lower in women with higher body mass index (BMI). The mean Bishop score was 3.97 ± 0.07 in multiparous women who had vaginal delivery vs. 3.56 ± 0.16 in women who had cesarean delivery (AOR = 1.5, 95% CI: 1.1–2.1, p = 0.01). The mean BMI was 30.24 ± 0.28 kg/m2 in multiparous women who had vaginal delivery vs. 32.36 ± 0.73 kg/m2 in women who had cesarean delivery (AOR = 0.89, 95% CI: 0.84–0.96, p = 0.005). 27% of nulliparous women who received more than two PGE2 tablets and 50% of multiparous women who received more than two PGE2 tablets had vaginal delivery with no significant increase in neonatal morbidity.ConclusionParity and cervical status are the main predictors of successful labour induction. Further studies are required to investigate the benefit of the use of additional doses of vaginal PGE2 above the recommended dose for IOL.

Predictors of Vaginal Delivery Following Stimulation of Uterine Contractions for Term Premature Rupture of Membranes

Context: Premature rupture of membranes (PROM) is a significant event as it may lead to maternal complications, increased operative procedure, neonatal morbidity, and mortality. Aim: To determine the predictors of successful vaginal delivery in pregnant women undergoing stimulation of uterine contractions following premature rupture of membranes (PROM). Settings and Design: This prospective cohort study was conducted at the University of Benin Teaching Hospital, Benin City, Nigeria. Materials and Methods: Seventy-four pregnant women between the gestational ages of 37 weeks and 41 weeks with a live singleton fetus in cephalic presentation and no contraindication to vaginal delivery who had stimulation of uterine contractions following term PROM were included in this study. The main outcome measure was the route of delivery. Statistical Analysis: The analysis was done with IBM statistical package for social science (SPSS) Statistics v21, and a P value ≤0.05 was considered statistically significant. Results: Sixty-two (83.8%) women had a vaginal delivery. The mean age and gestational age were 29.76 ± 3.69 years and 39.04 ± 1.15 weeks, respectively. The chance of vaginal delivery was increased with BMI &lt;30 (RR = 9.091, 95% CI = 1.827–45.246). The duration between rupture of membranes and commencement of stimulation of uterine contractions was ≤8 h (RR = 4.889, 95% CI = 1.307–18.293) also increasing the chance of achieving vaginal delivery. The time interval to 4 cm cervical dilatation ≤4 h (RR = 4.167, 95% CI = 1.141–15.215) and time interval to delivery ≤8 h (RR = 12.222, 95% CI = 2.433–61.402) also favored vaginal delivery. Conclusion: When uterine contractions are stimulated for PROM at term, vaginal delivery is predicted by maternal BMI &lt;30, duration of rupture of membrane ≤ 8 h, and time interval to 4 cm cervical dilatation ≤4 h. Also, it was found was that vaginal delivery becomes less likely when the time interval from stimulation to delivery exceeds 8 h.

Induction of labour – a misused blessing: Prospective study of factors influencing the success of induction and comparison of fetomaternal outcomes with spontaneous labour

Background. Although most pregnant women experience spontaneous labour at term, induction of labour is indicated whenever continuation of pregnancy is detrimental to either the fetus or the mother. Objectives . To study the factors associated with the successful induction of labour and to compare the maternal and fetal outcomes between induced and spontaneous labour . Methods. We conducted a prospective observational and comparative study from September 2015 to December 2016 at Dr TMA Pai Hospital – a secondary level hospital at Manipal Academy of Higher Education (MAHE). Women with a singleton pregnancy, live fetus, vertex presentation and gestational age (GA) &gt;36 weeks were included in the study, and those with antepartum haemorrhage, scarred uterus, anomalous fetus and intrauterine fetal demise were excluded. Results. Out of 1 575 deliveries during the study period, 550 were induced (34%). A total of 300 inductions fulfilled the inclusion criteria and formed the study group. Multiparity, body mass index (BMI) &lt;25 and gestational age (GA) &gt;38 weeks were factors associated with successful induction. Among the components of the Bishop score, dilatation was a better predictor of vaginal delivery ( p &lt;0.001) and post-dated pregnancy was the most common indication (33.6%). The rates of caesarean section (CS) delivery (33% v. 12%) and neonatal intensive care unit (NICU) admissions (4% v. 1%) were more in the induced group compared with the spontaneous group. Conclusion. Multiparity, BMI &lt;25 and advancing GA are predictors of successful induction. Induction is safe but carries a high risk of CS delivery and NICU admissions.

Prediction of vaginal delivery by using intrapartum ultrasound – a prospective cohort study

Non-invasive transperineal ultrasound is used to detect the descent of the fetal head by measuring head-perineum distance (HPD) and angle of progression (AP). The aim of the study was to evaluate HPD and AP as predictors of vaginal delivery in the first stage of labor. Methods: A prospective cohort study was made in Riga Maternity Hospital in Latvia in 2016. In the study were included nulliparous women with singleton pregnancies in cephalic presentation. HPD and AP were measured using transperineal ultrasoud. Demographic data, delivery parameters and birth outcomes were collected. Results: Of 36 women enrolled in the study, 26 (72.2%) had a vaginal delivery. The area under the receiver–operating characteristics curve was 0.865 (95% confidence interval (CI) 0.75-0.98) for the prediction of vaginal delivery using HPD as the test variable. The area under the curve was 0.877 (95% CI 0.77-0.99) using AP. All women delivered vaginally, if HPD was ≤40 mm (18 (50%) women). 8 (22.2%) of 18 women with HPD &gt;40 mm delivered vaginally (P&lt;0.001). 21 women of 22 (61.1%) with AP ≥105° delivered vaginally. In the other 14 (38.9%) women with AP &lt;105° 5 delivered vaginally (P&lt;0.001). Conclusions: Both HPD ≤ 40 mm and AP ≥ 105° are predictors for vaginal birth in the first stage of labor.

Prediction of vaginal deliveries using fetal head descent assessed by transperineal ultrasound

This study evaluated the use of transperineal ultrasound for predicting successful vaginal deliveries. This was a prognostic cohort design study conducted between March and May 2016 at the Karawang District Hospital, Indonesia. Inclusion criteria were term pregnancy, singleton live birth with head presentation, and active phase of labor. The fetal head-to-perineum distance and the angle of progression in the relaxation phase and between contractions were assessed by transperineal ultrasound. Data were analyzed using the Mann–Whitney U test, and the optimal cut-off was determined using receiver operating curves (ROC). A total of 306 women delivered vaginally during the study period. The cut-off for fetal head-to-perineum distance as a predictor of vaginal delivery was 43.5 mm (sensitivity, 91%; specificity, 78%), with an area under the curve of 82% (95% confidence interval [CI], 69%–95%; p < 0.01); the angle of progression was 107° (sensitivity, 80%; specificity, 97%), with an area under the curve of 96.4% (95% CI, 87%–99%, p < 0.01). In conclusion, fetal head-to-perineum distance and angle of progression can predict the success of vaginal deliveries.

Misoprostol vaginal insert versus misoprostol vaginal tablets for the induction of labour: a cohort study

BackgroundMisoprostol vaginal insert for induction of labor has been recently reported to be superior to dinoprostone vaginal insert in a phase III trial, but has never been compared to vaginal misoprostol in another galenic form. The aim of this study was to compare misoprostol vaginal insert (MVI) with misoprostol vaginal tablets (MVT) for induction of labor in term pregnancies.MethodsIn this retrospective cohort study we compared 200 consecutive women induced with 200-μg misoprostol 24-h vaginal insert (Misodel®) with a historical control of 200 women induced with Misoprostol 25-μg vaginal tablets (Cytotec®) every 4-6 h. Main outcomes variables included induction-to-delivery interval, vaginal delivery within 24-h, incidence of tachysystole, mode of delivery, and neonatal outcome. A subanalysis in the MVI group was performed in order to identify predictive factors for tachysistole and vaginal delivery within 24 h.ResultsThe time from induction to vaginal delivery was 1048 ± 814 min in the MVI group and 1510 ± 1043 min in the MVT group (p < 0.001). Vaginal delivery within 24-h occurred in 127 (63.5%) patients of the MVI group and in 110 (55%) patients of the MVT group (p < 0.001). Tachysystole was more common in the MVI group (36% vs. 18%; p < 0.001). However, no significant predictors of uterine tachysystole in MVI group have been identified in crude and fully adjusted logistic regression models. Bishop score was the only predictor for vaginal delivery within 24 h (p < 0.001) in MVI group. Caesarean delivery rate (27% vs. 20%) and vaginal-operative deliveries (15.5% vs. 15.5%) did not differ significantly between the two groups. Neonatal outcomes were similar in both groups.ConclusionsMVI achieves a more vaginal delivery rate within 24 h and Tachysystole events compared to MVT. However, no differences in caesarean section, operative vaginal delivery, and neonatal outcomes are reported. No predictors of tachysistole after MVI administration have been identified. Bishop score and parity are the only predictors of vaginal delivery within 24 h after MVI administration.

Prediction of Vaginal Delivery Using Fetal Head Descent Assessed Using Transperineal Ultrasound

Objective: To evaluate the use of transperineal ultrasound in predicting the successfulness of vaginal delivery.&#x0D; Methods: This was a prospective study conducted at Karawang District Hospital during the period between March 2016 and May 2016. Inclusion criteria were term pregnancy, singleton live head presentation, and active phase of labor. Using transperineal ultrasound, fetal head perineum distance, and angle of progression within relaxation phase between contraction were being calculated.&#x0D; Results: There were 306 subjects who delivered vaginally. The cut off value for fetal head perineum distance as a predictor of vaginal delivery was 43.5 mm (sensitivity 91%, specificity 78%), with area under a curve of 82% (95% CI 69 - 95%, p &lt; 0.01); while angle of progression is 107° (sensitivity 80 %, specificity 97%), with Area under curve is 96.4% (95% CI 87 - 99%, p &lt; 0.01).&#x0D; Conclusion: Fetal head perineum distance and angle of progression can predict the successfulness of vaginal delivery.&#x0D; [Indones J Obstet Gynecol 2017; 5-3: 149-153]&#x0D; Keywords: angle of progression, fetal head-perineum distance, prediction of vaginal delivery, transperineal ultrasound

Predictors of vaginal delivery in medically indicated early preterm induction of labor

When delivery is indicated prior to 34 weeks, many providers perform a cesarean delivery rather than induce labor based on perceptions of a high failure rate. Given the morbidity of cesarean delivery, an accurate estimate of the success rate and factors associated with success in preterm induction of labor is important in management decisions. We sought to develop a prediction model for successful induction of labor in preterm patients using factors known at the time the decision is made to deliver. A retrospective cohort study of all live singletons undergoing an indicated induction of labor between 23 and 34 0/7 weeks from 2011 through 2015. Pregnancies with major fetal anomalies or no intrapartum fetal monitoring were excluded. Successful induction of labor was defined as vaginal delivery. The cohort was randomly split into a training cohort to develop a prediction modelfor vaginal delivery and a validation cohort to test the model. Factors significantly associated with vaginal delivery were identified using univariate analyses, and candidate factors were used in the multivariate logistic regression model. Only factors known at the startof the induction of labor were used in the model. Receiver-operating characteristic curves were created to estimate the predictive value of the model. Sensitivity and specificity of the model were assessed. Of 331 patients who underwent induction of labor, 208(62.8%) delivered vaginally and 123 (37.1%) by cesarean delivery. Of the factors significantly associated with cesarean delivery, the final model included gestational age, simplified Bishop score, suspected intrauterine growth retardation, chronic hypertension, and body mass index. In the training cohort, the model correctly classified 72.3% of subjects with a sensitivity (cesarean delivery predicted/cesarean delivery performed) of 56.7% and a specificity (vaginal delivery predicted/vaginal delivery performed) of 84.1%. When applied to the validation cohort, 73.9% of subjects were correctly classified, with a sensitivity of 44.6% and specificity of 89.0%. Receiver-operating characteristic curves had an area under the curve of 0.75 for the training cohort and 0.77 for the validation cohort. More than 60% of women undergoing induction oflabor at <34 0/7 weeks deliver vaginally. For women undergoinginduction of labor at <34 0/7 weeks, this prediction model rarely classifies individuals who can have a vaginal delivery asneeding a cesarean delivery. This model may provide an accurateassessment tool to evaluate which patients will likely delivervaginally to avoid the morbidity of cesarean delivery while conversely identifying subjects at high risk of cesarean delivery <34 0/7 weeks.

418: Predictors of vaginal delivery in medically indicated preterm induction of labor

418: Predictors of vaginal delivery in medically indicated preterm induction of labor

Sonographic Cervical Shortening after Labor Induction is a Predictor of Vaginal Delivery.

Objective Analyzing if the sonographic evaluation of the cervix (cervical shortening) is a prognostic marker for vaginal delivery. Methods Women who underwent labor induction by using dinoprostone were enrolled. Before the induction and three hours after it, the cervical length was measured by ultrasonography to obtain the cervical shortening. The cervical shortening was introduced in logistic regression models among independent variables and for calculating receiver operating characteristic (ROC) curves. Results Each centimeter in the cervical shortening increases the odds of vaginal delivery in 24.4% within 6 hours; in 16.1% within 24 hours; and in 10.5% within 48 hours. The best predictions for vaginal delivery are achieved for births within 6 and 24 hours, while the cervical shortening poorly predicts vaginal delivery within 48 hours. Conclusion The greater the cervical shortening 3 hours after labor induction, the higher the likelihood of vaginal delivery within 6, 24 and 48 hours.

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.