Sonographic Cervical Length Measurement before Labor Induction in Term Nulliparous Women

Abstract

Objective: The purpose of the study was to determine if transvaginal sonographic measurement of the cervical length is a useful method to predict successful labor induction in nulliparas. Methods: 137 women who were scheduled for medically indicated induction of labor had a transvaginal sonographic measurement of the cervical length before labor induction. Inclusion criteria were: (1) singleton pregnancy; (2) gestational age between 37–42 weeks; (3) live fetus in cephalic presentation; (4) intact membranes; (5) no vaginal bleeding; (6) no previous history of uterine surgery; (7) nulliparous women, and (8) no allergy or asthma in response to prostaglandins. Induction of labor was performed within 6 h of the ultrasonographic examination, by inserting 2 mg of dinoprostone in the posterior vaginal fornix, repeated if needed every 6 h for up to three doses. When the cervix became favorable and no regular contractions were observed, amniotomy and oxytocin augmentation, starting at 1 mIU/min and increasing 1 mIU every 30 min as necessary, was performed. Results: All women were Caucasians and the mean age was 24.3 years (range 19–37 years). The mean cervical length was 28 mm (range 11–39 mm). The Bishop score was ≤5 in 101 women and >5 in the 36 others. Vaginal delivery occurred in 92 women (67.1%), and the vast majority of them (89 women; 96.7%) gave birth within 24 h of induction. Forty-five women (32.8%) had a cesarean section. The Bishop score was not predictive of the mode of delivery. Thirty-six of 101 women (35.6%) with a Bishop score ≤5 delivered by cesarean section, compared to 9 of 36 women with a Bishop score >5 (25%) (p = NS). Women with a cervical length <27 mm were more likely to deliver vaginally. Using this cutoff value the sensitivity of a successful labor induction was 76% and the specificity was 75.5%. Conclusions: Transvaginal sonographic measurement of cervical length is a good predictor of a successful labor induction at term in nulliparas.

Sonographic cervical length as a predictor of type of delivery after induced labor

“…In our study, the clinically most useful cut-oV points were similar to those of Gabriel et al (Bishop score 5 and cervical length 25.2 mm). Daskalakis et al [14] found that cervical length proved to be an independent predictor of a successful labor induction in nulliparas. Also, their cut-oV points were similar to those of Gabriel et al (Bishop score 5 and cervical length 27 mm).…”

“…Sonographic evaluation of cervical length is more objective and exact [6], and causes less discomfort to the patient. Nevertheless, studies comparing the relative usefulness of the Bishop score versus transvaginal cervical sonography in predicting the success of labor induction report discrepant results [7][8][9][10][11][12][13][14][15][16] as we stated before.…”

Evaluation of pre induction scoring by clinical examination vs transvaginal sonography

“…This study has compared the Bishop Score and cervical length by transvaginal ultrasound as in studies of Daskalakis et al 15 and Anish et al 16 . In studies of Yang et al 17 and Gomes et al 18 also, primigravidae were more in number than multigravidae with 74% and 68.1% respectively.…”

Digital and transvaginal ultrasound cervical assessment for prediction of successful labor induction

“…Meanwhile, Daskalakis et al [11] showed that women with preinduction cervical length b 27 mm were more likely to deliver vaginally.…”