Department of Obstetrics and Gynaecology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey.
Department of Perinatology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey.
Arch Gynecol Obstet. 2023 Oct;308(4):1301-1311. doi: 10.1007/s00404-023-07076-8. Epub 2023 May 21.
The study's aim is to define among a group of ultrasonographic cervical measurements a candidate parameter predictive of successful of induction of labor in term pregnancies with unfavorable cervix.
This prospective observational study included 141 pregnant women at term with an unfavorable cervix (Bishop score ≤ 6). All patients underwent clinical and ultrasonographic cervical evaluation before dinoprostone induction. Pre-induction cervical assessments included the Bishop score, cervical length, cervical volume, uterocervical angle, and cervical elastographic parameters. Vaginal delivery (VD) was accepted as successful dinoprostone induction. Multivariate logistic regression was conducted to identify the potential risk factors significantly associated with CS while controlling for possible confounding variables.
The vaginal delivery rate was 74% (n = 93) and the cesarean section (CS) rate was 26% (n = 32). Sixteen patients who had a cesarean section due to fetal distress before the active phase of labor were excluded from the study. The mean induction-to-delivery interval was 1176.1 ± 352 (540-2150) for VD and 1359.4 ± 318.4 (780-2020) for CS (p = 0.01). Bishop score was lower in women with cesarean section (p = 0.002). When both groups were compared in terms of delivery type, no difference was found between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. Multivariable logistic regression model failed to show significant differences between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements.
Cervical length, cervical elastography, cervical volume, and uterocervical angle measurements did not provide a clinically useful prediction of outcomes following labor induction in our study group with unfavorable cervix. Cervical length measurements significantly predicted the time interval from induction to delivery.
本研究旨在在一组超声宫颈测量中确定一个候选参数，该参数可预测具有不利宫颈的足月妊娠引产的成功率。
本前瞻性观察性研究纳入了 141 名足月且宫颈条件不佳（Bishop 评分≤6）的孕妇。所有患者均在行地诺前列酮引产前进行临床和超声宫颈评估。诱导前的宫颈评估包括 Bishop 评分、宫颈长度、宫颈体积、子宫颈角和宫颈弹性参数。阴道分娩（VD）被认为是成功的地诺前列酮引产。进行多变量逻辑回归以确定与 CS 显著相关的潜在风险因素，同时控制可能的混杂变量。
VD 率为 74%（n=93），CS 率为 26%（n=32）。因胎儿窘迫在活跃期前行剖宫产的 16 例患者被排除在研究之外。VD 的诱导至分娩间隔的平均值为 1176.1±352（540-2150），CS 的为 1359.4±318.4（780-2020）（p=0.01）。CS 组的 Bishop 评分较低（p=0.002）。当比较两组分娩方式时，在 CS 组中，宫颈弹性值、宫颈体积、宫颈长度和子宫颈角测量值之间没有差异。多变量逻辑回归模型未能显示宫颈弹性值、宫颈体积、宫颈长度和子宫颈角测量值之间的显著差异。
在本研究中，具有不利宫颈的孕妇中，宫颈长度、宫颈弹性、宫颈体积和子宫颈角测量均不能对引产结局进行有用的预测。宫颈长度测量显著预测了从诱导到分娩的时间间隔。
