Clinical factors and ultrasound parameters to predict successful vaginal delivery following labour induction

Diagnostic accuracy of pre-induction cervical elastography, volume, length, and uterocervical angle for the prediction of successful induction of labor with dinoprostone

PURPOSE

The study's aim is to define among a group of ultrasonographic cervical measurements a candidate parameter predictive of successful of induction of labor in term pregnancies with unfavorable cervix.

METHODS

This prospective observational study included 141 pregnant women at term with an unfavorable cervix (Bishop score ≤ 6). All patients underwent clinical and ultrasonographic cervical evaluation before dinoprostone induction. Pre-induction cervical assessments included the Bishop score, cervical length, cervical volume, uterocervical angle, and cervical elastographic parameters. Vaginal delivery (VD) was accepted as successful dinoprostone induction. Multivariate logistic regression was conducted to identify the potential risk factors significantly associated with CS while controlling for possible confounding variables.

RESULTS

The vaginal delivery rate was 74% (n = 93) and the cesarean section (CS) rate was 26% (n = 32). Sixteen patients who had a cesarean section due to fetal distress before the active phase of labor were excluded from the study. The mean induction-to-delivery interval was 1176.1 ± 352 (540-2150) for VD and 1359.4 ± 318.4 (780-2020) for CS (p = 0.01). Bishop score was lower in women with cesarean section (p = 0.002). When both groups were compared in terms of delivery type, no difference was found between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. Multivariable logistic regression model failed to show significant differences between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements.

CONCLUSION

Cervical length, cervical elastography, cervical volume, and uterocervical angle measurements did not provide a clinically useful prediction of outcomes following labor induction in our study group with unfavorable cervix. Cervical length measurements significantly predicted the time interval from induction to delivery.

Prognostic factors for successful induction of labor in intrauterine growth restriction after 36 weeks of gestation

OBJECTIVE

In comparison to eutrophic fetuses, intra uterine growth restriction fetuses (IUGR) have a higher risk of perinatal morbi-mortality. There are no guidelines on the labor induction of labor (IOL) method to be performed in IUGR. The main objective was to determine fetal and maternal predictive factors of successful induction in IUGR fetuses from 36 weeks. Study design We conducted a retrospective cohort single-center study including 320 women with a cephalic fetal presentation. Labour was induced after 36 weeks for suspected IUGR between January 2013 and December 2019.

RESULTS

Among the 320 patients, 246 were delivered vaginally (76.9 %) and 74 had a cesarean (23.1 %). Prognostic factors for successful IUGR induction were nonscarring uterus (OR 8.41; 95 %CI [2.92-24.21]), absence of preeclampsia (OR 7.14; 95 %CI [2.42-21.03]), multiparity (OR 4.32; 95 %CI [1.83-10.18]), normal fetal heart rate before IOL (OR 2.99; 95 %CI [1.24-7.22]) and BMI < 30 (OR 3.54; 95 %CI [1.62-7.72]). Doppler abnormalities, method and number of line of IOL, cervical evaluation were not significant in our study.

CONCLUSION

The prognostic factors for successful IUGR induction are essentially maternal. Thus, a low BMI, multiparity, nonscarring uterus, absence of preeclampsia, and a normal FHR are good prognostic factors in IUGR induction.

Association between interleukin-6 levels in amniotic fluid after rupture of membranes during labour at term pregnancy and successful vaginal delivery: a prospective cohort study

We compared the mean interleukin-6 (IL-6) level in the amniotic fluid after rupture of membranes during labour at term pregnancy according to the delivery methods through prospective cohort study. Cases with premature rupture of membranes, multifetal pregnancy, and major congenital anomalies were excluded. Amniotic fluid was obtained from vaginal canal immediately after spontaneous rupture of membranes. A total of 47 cases were analysed, and 72.3% (34/47) had successful vaginal delivery. The mean concentration of IL-6 in the amniotic fluid was significantly higher in the vaginal delivery group than in the caesarean section group (5,229 pg/mL vs. 1,702 pg/mL, p = .022). The concentration of IL-6 from the amniotic fluid tended to increase as the cervical dilatation increased. The association between high IL-6 level (>2,500 pg/mL) and successful vaginal delivery was not significant after adjusting the degree of cervical dilatation in multivariate logistic regression analysis. IMPACT STATEMENTWhat is already known on this subject? Multiparity, active and strong uterine contractions, dilated cervical os, and the position of foetal head are known clinical factors affecting the successful vaginal delivery. There are few studies on markers for successful vaginal delivery in patients with labour.What do the results of this study add? The mean value of IL-6 concentration from the amniotic fluid collected from vagina immediately after rupture of membranes was significantly higher in the patients who had resulted in successful vaginal delivery than those who had failed.What are the implications are of these findings for clinical practice and/or further research? Measurement of IL-6 concentration in the amniotic fluid from vaginal canal in patients with labour might help to predict the successful vaginal delivery and shorten the time before decision of caesarean section.

Effect of maternal age on maternal and perinatal outcomes including cesarean delivery following induction of labor in uncomplicated elderly primigravidae

ABSTRACT

Age above 35 years at the time of birth is generally referred to as advanced maternal age (AMA), and it could be a risk factor for various complications besides genetic changes in the fetus. The primary outcome of this study was to determine if AMA is associated with emergent cesarean delivery (CD) following induction of labor (IOL). The secondary outcomes were a composite of adverse maternal and perinatal outcomes following IOL.This retrospective observational study included women with singleton, live-born, cephalic, non-anomalous pregnancies undergoing IOL from 38 0/7 to 41 6/7 weeks of gestation. Mode of delivery and other maternal and neonatal outcomes were compared between women aged ≥35 (AMA) and <35 years. Multivariate logistic regression analyses were performed.A total of 307 nulliparous women underwent IOL (≥35 years n = 73, 23.8%; <35 years n = 234, 76.2%) and among them, 252 (82.1%) delivered vaginally. The rate of CD was significantly higher in women of AMA (31.5% vs 13.7%, P = .001). Multivariable analysis showed that AMA was independently associated with CD (odds ratio 3.04, 95% confidence interval 1.55-5.96, P = .001). The rate of instrumental deliveries was higher in the AMA group (19.6% vs 8.2%, P = .043) and hemoglobin decrease during delivery was similar between the 2 groups (1.90 ± 1.25 vs 2.02 ± 1.27 mg/dL, all P > .05). Regarding neonatal outcomes, there was no difference between the 2 groups in the neonatal intensive care unit admission rate and Apgar score <7 at 5 minutes (30.3% vs 30.1% and 6.0% vs 8.2%, respectively, all P > .05). Neonatal intubation rate and severe respiratory problems were non-significantly higher in AMA (3.8% vs 2.7% and 3.4% vs 1.4%, respectively, all P > .05).AMA was associated with an approximately three-fold increased likelihood of birth by CD and operative vaginal delivery in uncomplicated nulliparous women following IOL. However, we found no evidence that IOL in primigravid women of AMA increases adverse maternal and perinatal outcomes as compared with women aged <35 years except the high prevalence of CD and operative vaginal delivery.