Sonographic Cervical Shortening after Labor Induction is a Predictor of Vaginal Delivery

Abstract

Objective Analyzing if the sonographic evaluation of the cervix (cervical shortening) is a prognostic marker for vaginal delivery.

Methods Women who underwent labor induction by using dinoprostone were enrolled. Before the induction and three hours after it, the cervical length was measured by ultrasonography to obtain the cervical shortening. The cervical shortening was introduced in logistic regression models among independent variables and for calculating receiver operating characteristic (ROC) curves.

Results Each centimeter in the cervical shortening increases the odds of vaginal delivery in 24.4% within 6 hours; in 16.1% within 24 hours; and in 10.5% within 48 hours. The best predictions for vaginal delivery are achieved for births within 6 and 24 hours, while the cervical shortening poorly predicts vaginal delivery within 48 hours.

Conclusion The greater the cervical shortening 3 hours after labor induction, the higher the likelihood of vaginal delivery within 6, 24 and 48 hours.

Resumo

Objetivo Analisar se a avaliação ultrassonográfica do colo do útero (encurtamento) é um marcador prognóstico para parto normal.

Métodos Consideramos mulheres com trabalho de parto induzido usando dinoprostona. Antes da indução e três horas após, a extensão cervical foi medida por ultrassonografia para obter o encurtamento do colo do útero. O encurtamento do colo do útero foi aplicado em modelos de regressão dentre variáveis independentes. Curvas de Característica de Operação do Receptor foram calculadas.

Resultados Cada centímetro no encurtamento do colo do útero aumenta as chances de parto normal para 24,4% dentro de 6 horas; 16,1% dentro de 24 horas; e 10,5% dentro de 48 horas. Os melhores preditores de parto normal são alcançados para partos dentre 6 e 24 horas, enquanto o encurtamento prevê mal o parto normal dentro de 48 horas.

Conclusão Quanto maior o encurtamento do colo do útero 3 horas após a indução do parto, maiores são as chances de parto normal em 6, 24 e 48 horas.

Keywords

cervical shortening - delivery outcome - transvaginal ultrasonography - labor induction

Palavras-chave

encurtamento do colo do útero - resultado do parto - ultrassonografia transvaginal - indução do parto

• References

• 1 Teixeira C, Lunet N, Rodrigues T, Barros H. The Bishop Score as a determinant of labour induction success: a systematic review and meta-analysis. Arch Gynecol Obstet 2012; 286 (03) 739-753
• 2 Verhoeven CJ, Opmeer BC, Oei SG, Latour V, van der Post JA, Mol BW. Transvaginal sonographic assessment of cervical length and wedging for predicting outcome of labor induction at term: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2013; 42 (05) 500-508
• 3 Wozniak S, Czuczwar P, Szkodziak P, Paszkowski T. Usefulness of elastography in predicting the outcome of Foley catheter labour induction. Aust N Z J Obstet Gynaecol 2015; 55 (03) 245-250
• 4 Kang WS, Park KH, Kim SN, Shin DM, Hong JS, Jung HJ. Degree of cervical shortening after initial induction of labor as a predictor of subsequent successful induction. Ultrasound Obstet Gynecol 2010; 36 (06) 749-754
• 5 Papillon-Smith J, Abenhaim HA. The role of sonographic cervical length in labor induction at term. J Clin Ultrasound 2015; 43 (01) 7-16
• 6 Ezebialu IU, Eke AC, Eleje GU, Nwachukwu CE. Methods for assessing pre-induction cervical ripening. Cochrane Database Syst Rev 2015; (06) CD010762
• 7 Fruscalzo A, Mazza E, Feltovich H, Schmitz R. Cervical elastography during pregnancy: a critical review of current approaches with a focus on controversies and limitations. J Med Ultrason (2001) 2016; 43 (04) 493-504