背景:Bishop评分(BS)已用于观察宫颈对引产(IOL)的有利性,但它在当今多样化的患者群体中存在局限性。我们旨在评估经阴道超声(TVUS)测量宫颈长度(CL)与BS相比的预测价值,以确定IOL后剖宫产(CS)的可能性。
方法:在印度中部的一家三级保健医院对120名需要IOL的妇女进行了一项前瞻性观察性研究。该研究的纳入标准是18岁以上的产前妇女,需要IOL,从最后一次月经期之日起确定的孕龄>37周的单胎妊娠,并在妊娠早期通过超声检查确认,呈现头部呈现,有完整的胎膜.先前有子宫疤痕的妇女和不愿意IOL的妇女被排除在研究之外。TVUS是在诱导前完成的。进行统计分析以比较CL和BS对CS的预测能力。
结果:平均年龄和妊娠期为25.96岁39周3天,分别。大多数研究人群包括多重妊娠(69,57.5%),其次是primigravida(47,39.2%),和多重妊娠(≥G5)(4,3.3%)。到期后(34,28.3%),先兆子痫(21,17.5%),妊娠肝内胆汁淤积症(17,14.2%)是常见的诱导指征。总体CS率为35.8%(43/120)。患有CS的女性BS较低(3.60vs.4.70,P=0.010)和更高的CL(31.5mmvs.23.4mm,P<0.001)。CL表现出0.857的曲线下面积(AUC),在预测CS方面优于BS(AUC=0.643)。使用26.5mm的CL截止值产生灵敏度(79.1%),特异性(81.8%),和整体精度(80.8%)。
结论:TVUS测量CL(>26.5mm)对引产后CS的预测能力优于BS(≤5)。这项研究强调了CL测量作为优化引产决策的客观可靠工具的潜力。
BACKGROUND: Bishop score (BS) has been used to see the favorability of the cervix for induction of labor (IOL), but it has limitations in today\'s diverse patient population. We aimed to assess the predictive value of transvaginal ultrasound (TVUS) measurements of cervical length (CL) compared to BS in determining the likelihood of cesarean section (CS) following IOL.
METHODS: A prospective observational study was conducted on 120 women requiring IOL in a tertiary care hospital in central India. The inclusion criteria of the study were antenatal women more than 18 years of age, in need of IOL, having a singleton pregnancy with a gestational age of > 37 weeks as determined from the date of the last menstrual period and confirmed by sonographic measurements in the first trimester, presenting with a cephalic presentation, and having intact fetal membranes. Women with prior uterine scars and those unwilling to IOL were excluded from the study. TVUS was done just before induction. Statistical analyses were done to compare the predictive abilities of CL and BS for CS.
RESULTS: The mean age and gestation period were 25.96 years and 39 weeks 3 days, respectively. The majority of the study population comprised multigravida (69, 57.5%), followed by primigravida (47, 39.2%), and grand multigravida (≥ G5) (4, 3.3%). Post-maturity (34, 28.3%), preeclampsia (21, 17.5%), and intrahepatic cholestasis of pregnancy (17, 14.2%) were common indications for induction. The overall CS rate was 35.8% (43/120). Women with CS had lower BS (3.60 vs. 4.70, P = 0.010) and higher CL (31.5 mm vs. 23.4 mm, P < 0.001). CL exhibited an area under the curve (AUC) of 0.857, outperforming BS (AUC = 0.643) in predicting CS. Using a CL cutoff of 26.5 mm yielded sensitivity (79.1%), specificity (81.8%), and overall accuracy (80.8%).
CONCLUSIONS: TVUS measurement of CL (>26.5 mm) demonstrated superior predictive ability for CS following labor induction compared to BS (≤5). This study highlights the potential of CL measurement as an objective and reliable tool for optimizing decision-making in labor induction.