Deif Osama, Messallami Muhammed El, Diab Yasser
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
J Family Reprod Health. 2024 Mar;18(1):53-59. doi: 10.18502/jfrh.v18i1.15439.
Precise assessment of cervical conditions before labor induction is crucial for predicting the success of normal vaginal delivery. The cervix primary condition has a significant value in determining the succession of induction of labour. Traditionally, assessment of cervix before induction has been based on a cervix digital examination using Bishop's scoring method.This study compares transvaginal ultrasonographic (TVS) cervical assessment with the traditional Bishop score in nulliparous women undergoing labor induction, aiming to evaluate their predictive abilities for labor dystocia.
In a prospective observational study of 200 pregnant women at Al Hussein University Hospital between October 2022 and July 2023, cervical length, funneling, and posterior cervical angle were measured using transvaginal ultrasound. The Bishop score was recorded before induction. Statistical analyses, including Student's "t"-test and ROC curve, were conducted using SPSS.
68% delivered via normal vaginal delivery (NVD) and 32% via cesarean section (CS). The NVD group exhibited significantly higher Bishop scores (6.82±1.36 vs 3.70±0.94), lower cervical length (25.46±3.99 vs 37.34±2.09), and higher cervical angle (121.39±5.70 vs 89.01±6.09), than the CS group. ROC curve analysis revealed that a Bishop score ≥4.5 had 89% sensitivity and 87.5% specificity, a cervical angle ≥ 92.5 had 98.5% sensitivity and 95.3% specificity, and a cervical length ≥31.5 had 96.9% sensitivity and 97.1% specificity for predicting NVD.
The posterior cervical angle, alongside cervical length, proves to be a more sensitive indicator for predicting labor dystocia during induction compared to the traditional Bishop score.
引产之前对宫颈状况进行精确评估对于预测正常阴道分娩的成功至关重要。宫颈的初始状况在确定引产的后续情况方面具有重要价值。传统上，引产之前对宫颈的评估是基于使用 Bishop 评分法的宫颈指检。本研究比较了引产的未产妇经阴道超声（TVS）宫颈评估与传统 Bishop 评分，旨在评估它们对产程异常的预测能力。
在 2022 年 10 月至 2023 年 7 月期间于侯赛因大学医院对 200 名孕妇进行的一项前瞻性观察研究中，使用经阴道超声测量宫颈长度、漏斗形成及宫颈后角。引产之前记录 Bishop 评分。使用 SPSS 进行包括 Student's “t”检验和 ROC 曲线在内的统计分析。
68% 通过正常阴道分娩（NVD），32% 通过剖宫产（CS）。与 CS 组相比，NVD 组的 Bishop 评分显著更高（6.82±1.36 对 3.70±0.94），宫颈长度更低（25.46±3.99 对 37.34±2.09），且宫颈角更高（121.39±5.70 对 89.01±6.09）。ROC 曲线分析显示，Bishop 评分≥4.5 对预测 NVD 的敏感性为 89%，特异性为 87.5%；宫颈角≥92.5 对预测 NVD 的敏感性为 98.5%，特异性为 95.3%；宫颈长度≥31.5 对预测 NVD 的敏感性为 96.9%，特异性为 97.1%。
与传统 Bishop 评分相比，宫颈后角与宫颈长度一起被证明是引产期间预测产程异常的更敏感指标。
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