Gabriel R, Darnaud T, Chalot F, Gonzalez N, Leymarie F, Quereux C
Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire, Reims, France.
Ultrasound Obstet Gynecol. 2002 Mar;19(3):254-7. doi: 10.1046/j.1469-0705.2002.00643.x.
To compare the Bishop score and transvaginal sonographic measurement of cervical length for predicting the mode of delivery following medically indicated induction of labor in term patients.
The study was conducted prospectively in 179 women who required medically indicated induction of labor. Inclusion criteria were singleton pregnancy, gestational age > 37 weeks of amenorrhea, cephalic presentation and intact fetal membranes. Cervical length was measured upon arrival in the labor room but was not considered when choosing the induction procedure. Two receiver-operating characteristic curves were plotted to calculate the best threshold value for the Bishop score and for cervical length for predicting the risk of Cesarean section.
Fifty-three women (29.6%) had a Cesarean section. The Bishop score was not predictive of the delivery mode, although Cesarean section for failure to progress was more frequent when the Bishop score was < or = 5. Among the women with a Bishop score > 5, the cervical length was not predictive of the induction outcome. However, among the women with a Bishop score < or = 5, a cervical length < 26 mm was associated with a lower Cesarean section rate (20.6 vs. 42.9%; P = 0.006). Furthermore, the interval between the beginning of cervical ripening and delivery was shorter in the case of a short cervix (11.01 +/- 6.7 vs. 18.55 +/- 7.07 h; P < 10(-5)).
The length of the uterine cervix, measured by transvaginal sonography, is a better predictor of the risk of Cesarean section than the Bishop score after induction of labor for medical reasons. In women with an unfavorable Bishop score, a cervical length of < 26 mm is associated with a lower risk of Cesarean section and a shorter duration of labor.
比较Bishop评分与经阴道超声测量宫颈长度，以预测足月患者因医学指征引产的分娩方式。
对179例因医学指征需要引产的女性进行前瞻性研究。纳入标准为单胎妊娠、停经孕周>37周、头先露且胎膜完整。产妇进入产房后测量宫颈长度，但在选择引产方法时不考虑该因素。绘制两条受试者工作特征曲线，以计算Bishop评分和宫颈长度预测剖宫产风险的最佳阈值。
53例女性（29.6%）接受了剖宫产。Bishop评分不能预测分娩方式，尽管当Bishop评分≤5分时，因产程无进展而行剖宫产的情况更为常见。在Bishop评分>5分的女性中，宫颈长度不能预测引产结局。然而，在Bishop评分≤5分的女性中，宫颈长度<26mm与较低的剖宫产率相关（20.6%对42.9%；P=0.006）。此外，宫颈短的产妇宫颈成熟开始至分娩的间隔时间较短（11.01±6.7小时对18.55±7.07小时；P<10⁻⁵）。
经阴道超声测量的宫颈长度，比因医学原因引产术后的Bishop评分，能更好地预测剖宫产风险。对于Bishop评分不佳的女性，宫颈长度<26mm与较低的剖宫产风险及较短的产程相关。
