Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel.
Arch Gynecol Obstet. 2021 Apr;303(4):891-896. doi: 10.1007/s00404-020-05811-z. Epub 2020 Sep 29.
Several attempts have been made to find tools for the prediction of successful induction of labor. Sonographic myometrial thickness has not yet been investigated regarding its use as a clinical tool for the course of labor induction.
To evaluate the role of sonographic measurement of myometrial thickness in the prediction of the time interval to successful vaginal delivery after induction of labor.
A prospective study was conducted including term singleton pregnancies with a vertex presentation designated for balloon induction at 38-42 weeks gestation. Prior to induction, abdominal sonographic myometrial thickness was assessed at five locations: lower uterine segment (above and below the reflection of the urinary bladder), mid-anterior wall, fundus and posterior uterine wall. Induction of labor was then carried out with a trans-cervical Foley catheter that was substituted with intravenous oxytocin after balloon expulsion. The parameters assessed were successful induction of labor resulting in a vaginal delivery and the time interval from balloon insertion to balloon expulsion, the time interval from initiation of oxytocin administration to delivery and the total time from balloon insertion to delivery.
Fifty-two women were recruited to the study. Indications for labor induction were: post-date pregnancy (48.1%), gestational diabetes mellitus (19.2%), oligohydramnios (11.5%), gestational hypertensive disorders (5.8%) and other indications (15.4%). Vaginal delivery was achieved in 46 patients (88.5%). A statistically significant correlation was found between fundal and posterior uterine wall myometrial thickness and time from induction to balloon expulsion (r = 0.36, p = 0.03; r = - 0.35, p = 0.05, respectively). This correlation remained significant in a multivariate logistic regression model controlling for confounders. A correlation between myometrial thickness and the total time from induction to delivery was not statistically significant.
Myometrial fundal and posterior uterine wall thickness in women undergoing labor induction with a balloon catheter was found to be correlated with the interval from balloon insertion to expulsion. Our findings support further investigations into the use of sonographic myometrial thickness as part of the assessment prior to induction of labor.
人们曾多次尝试寻找预测引产成功的工具。目前尚未研究超声测量子宫肌层厚度能否作为预测引产过程中分娩时间的临床工具。
评估超声测量子宫肌层厚度在预测诱导分娩后成功阴道分娩的时间间隔中的作用。
这是一项前瞻性研究，纳入了 38-42 孕周、具有头位、拟行球囊引产的单胎足月妊娠患者。在引产之前，在五个部位（子宫下段[膀胱反射上方和下方]、前壁中部、宫底和后壁）进行腹部超声子宫肌层厚度评估。然后，通过经宫颈 Foley 导管进行引产，球囊排出后用静脉滴注催产素替代。评估的参数包括成功引产并分娩，以及从球囊插入到球囊排出、从催产素给药开始到分娩以及从球囊插入到分娩的总时间。
共招募了 52 名妇女进行研究。引产指征为：过期妊娠（48.1%）、妊娠期糖尿病（19.2%）、羊水过少（11.5%）、妊娠高血压疾病（5.8%）和其他指征（15.4%）。46 名患者（88.5%）实现了阴道分娩。宫底和子宫后壁肌层厚度与从诱导到球囊排出的时间之间存在统计学显著相关性（r=0.36，p=0.03；r=-0.35，p=0.05）。在控制混杂因素的多变量逻辑回归模型中，这种相关性仍然显著。子宫肌层厚度与从诱导到分娩的总时间之间的相关性无统计学意义。
在使用球囊导管进行引产的妇女中，子宫肌层的宫底和子宫后壁厚度与从球囊插入到排出的时间间隔相关。我们的发现支持进一步研究将超声子宫肌层厚度作为分娩前评估的一部分。
