Roman H, Verspyck E, Vercoustre L, Degre S, Col J Y, Firmin J M, Caron P, Marpeau L
Department of Gynaecology and Obstetrics, General Hospital, Le Havre, France.
Ultrasound Obstet Gynecol. 2004 Apr;23(4):357-62. doi: 10.1002/uog.1008.
To compare the Bishop score, ultrasound cervical parameters and fetal fibronectin assessment for predicting failed labor induction when the cervix is unfavorable.
A prospective observational study was performed in 106 consecutive pregnant women with a Bishop score < or =5 undergoing labor induction. Assessment of fetal fibronectin and ultrasound measurement of cervical length, cervical wedging and cervical lip areas were performed. The relationship between these parameters and failure of labor induction was determined.
Failure of labor induction was defined as failure to reach a cervical dilatation of > or =5 cm, and it occurred in 16 patients (15.1%). Induction failure was associated with low Bishop scores before (P = 0.004) and 6 h after the start of induction (P = 0.007), increased clinical cervical length (P = 0.02) and increased ultrasound anterior cervical lip area (P = 0.04). The logistic regression model identified the Bishop score before induction (odds ratio = 2.25; 95% CI, 1.30-3.91; P = 0.003) and the clinical cervical length (odds ratio = 3.95; 95% CI, 1.3-11.7; P = 0.01) as being independent predictors of failed induction. To predict an induction failure, the best Bishop score cut-off value was 4, with a sensitivity of 87.5%, a specificity of 45.6%, a likelihood ratio of 1.58, a positive predictive value of 22.2% and a negative predictive value of 95.4%.
Compared with the Bishop score, cervical length by ultrasound is not a better predictor for the outcome of labor induction in an unfavorable cervix. Nevertheless, the Bishop score appears to be of poor predictive value for failed induction of labor.
比较Bishop评分、超声宫颈参数及胎儿纤连蛋白评估在预测宫颈条件不佳时引产失败的情况。
对106例连续接受引产且Bishop评分≤5分的孕妇进行前瞻性观察研究。进行胎儿纤连蛋白评估及宫颈长度、宫颈楔入面积和宫颈唇面积的超声测量。确定这些参数与引产失败之间的关系。
引产失败定义为宫颈扩张未达到≥5cm，16例患者（15.1%）出现引产失败。引产失败与引产开始前（P = 0.004）和开始后6小时（P = 0.007）的低Bishop评分、临床宫颈长度增加（P = 0.02）及超声测量的宫颈前唇面积增加（P = 0.04）相关。逻辑回归模型确定引产开始前的Bishop评分（比值比 = 2.25；95%可信区间，1.30 - 3.91；P = 0.003）和临床宫颈长度（比值比 = 3.95；95%可信区间，1.3 - 11.7；P = 0.01）为引产失败的独立预测因素。为预测引产失败，最佳Bishop评分临界值为4分，敏感性为87.5%，特异性为45.6%，似然比为1.58，阳性预测值为22.2%，阴性预测值为95.4%。
与Bishop评分相比，超声测量的宫颈长度并非预测宫颈条件不佳时引产结局的更好指标。然而，Bishop评分对引产失败的预测价值似乎较差。
