A Prospective Study to predict Vaginal Cytology and Bishop Score as Predictors of Onset of Labor

Abstract

Jasneet Dhingra et al 222 Cover letter:Vaginal cytology reflects changes in estrogen and progesterone in pregnancy. The change represents a transition from predominance of navicular cells and clusters of intermediate cells (evidence of progesterone) to appearance of fewer or small sheets of clusters with abundance of superficial cells (evidence of progesterone withdrawal) at the onset of labor. Thus, vaginal cytology is a simple and inexpensive parameter to predict the onset of labor with ease. The vaginal smear yields unsurpassed speed and convenience.Bishop score, a clinical parameter also predicts the onset of labor. At the onset of labor, Bishop score improves. ABStrACtAim: To study the changes in vaginal cytology and Bishop score in term pregnancy; to evaluate vaginal cytology and Bishop score as predictors of onset of labor and to compare individual and combined efficacy of both parameters. Materials and methods:The study was conducted in Department of Obstetrics and Gynecology in Subharti Medical College, Meerut.All antenatal patients, who were at term or at risk of preterm delivery [such as those presenting with preterm premature rupture of membranes (PPROM) or with warning signs for preterm labor], were enrolled as the study subject. Patients who were already in established labor or subjected to elective cesarean section were excluded from the study.Each subject was explained about the nature of study and informed written consent was taken. Per speculum examination was done. Leaking, if present, was noted and confirmed with pH change and fern test. Smear were taken from upper one-third of vaginal wall prior and smeared on a glass slide and was fixed in alcohol and stained according to Papanicolaou method. In each smear, individual cell characteristics as well as degree of desquamation was noted.The condition of cervix was evaluated by means of Bishop score. The Bishop score thus estimated was recorded in the working proforma.The patient's vaginal smear for cytology and repeat Bishop score was taken every 24 hours, till the onset of labor. Date and time of onset of labor was noted. Results:The maximum number of subjects were seen in the age category 18 to 24. Most of the women were primi gravida and were between 38 and 39 gestational age group. The decrease in number of clusters at the onset of labor was found statistically significant. Bishop score is increased at the onset of labor as compared to prelabor. Conclusion:Vaginal cytology is a simple and inexpensive parameter to predict the onset of labor with ease. The vaginal smear yields unsurpassed speed and convenience.Bishop score, a clinical parameter, also predicts the onset of labor. At the onset of labor, Bishop score improves.