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Objective Labor induction does not always result in vaginal delivery, and can expose both the mother and the fetus to the risks inherent to the induction procedure or a possible cesarean section. Transvaginal sonography (TVS) of the cervix is a useful tool to predict prematurity; in the present study, this tool was used to evaluate postterm induction. Methods We evaluated the ultrasound characteristics of the cervix (cervical length, cervical funneling, internal os dilation, the presence or absence of the cervical gland area [CGA], and the morphological changes of the cervix as a result of applying fundal pressure) before the onset of labor induction among women with postterm pregnancy to identify the possible predictors of failed labor induction. The Bishop score (BS) was used for comparison purposes. Three groups were evaluated: successful versus unsuccessful induction; vaginal delivery versus cesarean delivery (excluding cases of acute fetal distress [AFD]); and vaginal delivery versus cesarean delivery (including cases of AFD). A fourth group including only the primiparous women from the three previous groups was also evaluated. Results Based on the studied characteristics and combinations of variables, a cervical length ≥ 3.0 cm and a BS ≤ 2 were the best predictors of induction failure. Conclusion Although TVS is useful for screening for induction failure, this tool should not be used as an indication for cesarean section.

Aim There is much discussion about the advantages and disadvantages of a trial of labor after cesarean (TOLAC). Some data suggest the greater the likelihood of success, the lower the risks of TOLAC. Our goal was to identify clinical and demographic variables associated with a failed TOLAC, available at admission for spontaneous labor and until 3 h later, with the aim of building two scores for risk of failed TOLAC. Methods This is a nested case–control study with live births to women with one previous cesarean, in a public Brazilian teaching hospital. Preterm, induction, noncephalic presentations, twins, fetal malformations were excluded. Cases were failed TOLAC, and controls, the successful TOLAC. It was accessed the association of the cases with 20 variables (P < 0.05). Associated variables were tested in multivariate analysis to build the scores, which were internally validated. Results We included 260 TOLAC, 42 cases and 218 controls. We found 11 variables associated with failed TOLAC. In the score to be applied at admission, we included hypertension, fundal height, previous vaginal birth and dilatation at admission. In the second score hypertension, fundal height at admission, membrane status and difference in dilatation 3 h after admission. Both scores presented good performance in the receiver‐operator curve (areas under curve: 0.73 and 0.84, respectively). Both scores were translated into nomograms for clinical use. Conclusion Two scores were built for risk of failed TOLAC, to be applied at admission and 3 h later. We believe that choosing the more favorable cases makes risks of TOLAC lower.