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İleri A, Yıldırım Karaca S, Gölbaşı H, Adıyeke M, Budak A, Özer M, İleri H, Biçer M, Şenkaya AR, Arı SA, Çeliker Tosun Ö, Karaca İ. Diagnostic accuracy of pre-induction cervical elastography, volume, length, and uterocervical angle for the prediction of successful induction of labor with dinoprostone. Arch Gynecol Obstet 2023; 308:1301-1311. [PMID: 37210702 DOI: 10.1007/s00404-023-07076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
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.
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Affiliation(s)
- Alper İleri
- Department of Obstetrics and Gynaecology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey.
| | - Suna Yıldırım Karaca
- Department of Obstetrics and Gynaecology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey
| | - Hakan Gölbaşı
- Department of Perinatology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey
| | - Mehmet Adıyeke
- Department of Obstetrics and Gynaecology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey
| | - Adnan Budak
- Department of Obstetrics and Gynaecology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey
| | - Mehmet Özer
- Department of Perinatology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey
| | - Hande İleri
- Department of Family Medicine, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey
| | - Merve Biçer
- Private Clinic, Obstetrics and Gynecology, İzmir, Turkey
| | - Ayse Rabia Şenkaya
- Çiğli Education and Research Hospital, Department of Obstetrics and Gynaecology, İzmir Bakircay University, İzmir, Turkey
| | - Sabahattin Anıl Arı
- Çiğli Education and Research Hospital, Department of Obstetrics and Gynaecology, İzmir Bakircay University, İzmir, Turkey
| | - Özge Çeliker Tosun
- Department of Physical Therapy and Rehabilitation, Dokuz Eylul University, İzmir, Turkey
| | - İbrahim Karaca
- Çiğli Education and Research Hospital, Department of Obstetrics and Gynaecology, İzmir Bakircay University, İzmir, Turkey
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Pinto V, Dellino M, Santarsiero CM, Cormio G, Loizzi V, Griseta V, Vimercati A, Cazzato G, Cascardi E, Cicinelli E. Ultrasound Control of Cervical Regeneration after Large Loop Excision of the Transformation Zone: Results of an Innovative Measurement Technique. Diagnostics (Basel) 2023; 13:diagnostics13040791. [PMID: 36832279 PMCID: PMC9955376 DOI: 10.3390/diagnostics13040791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/05/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
The objective of this research is to evaluate cervical regeneration after large loop excision of the transformation zone (LLETZ) through the identification of a new sonographic reference point at the level of the uterine margins. In the period March 2021-January 2022, a total of 42 patients affected by CIN 2-3 were treated with LLETZ at the University Hospital of Bari (Italy). Before performing LLETZ, cervical length and volume were measured with trans-vaginal 3D ultrasound. From the multiplanar images, the cervical volume was obtained using the Virtual Organ Computer-aided AnaLysis (VOCAL™) program with manual contour mode. The line that connects the points where the common trunk of the uterine arteries reaches the uterus splitting into the ascending major branch and the cervical branch was considered as the upper limit of the cervical canal. From the acquired 3D volume, the length and the volume of the cervix were measured between this line and the external uterine os. Immediately after LLETZ, the removed cone was measured using Vernier's caliper, and before fixation in formalin, the volume of the excised tissue was evaluated by the fluid displacement technique based on the Archimedes principle. The proportion of excised cervical volume was 25.50 ± 17.43%. The volume and the height of the excised cone were 1.61 ± 0.82 mL and 9.65 ± 2.49 mm corresponding to 14.74 ± 11.91% and 36.26 ± 15.49% of baseline values, respectively. The volume and length of the residual cervix were also assessed using 3D ultrasound up to the sixth month after excision. At 6 weeks, about 50% of cases reported an unchanged or lower cervical volume compared to the baseline pre-LLETZ values. The average percentage of volume regeneration in examined patients was equal to 9.77 ± 55.33%. In the same period, the cervical length regeneration rate was 69.41 ± 14.8%. Three months after LLETZ, a volume regeneration rate of 41.36 ± 28.31% was found. For the length, an average regeneration rate of 82.48 ± 15.25% was calculated. Finally, at 6 months, the percentage of regeneration of the excised volume was 90.99 ± 34.91%. The regrowth percentage of the cervical length was 91.07 ± 8.03%. The cervix measurement technique that we have proposed has the advantage of identifying an unequivocal reference point in 3D cervical measurement. Ultrasound 3D evaluation could be useful in the clinical practice to evaluate the cervical tissue deficit and express the "potential of cervical regeneration" as well as provide the surgeon useful information about the cervical length.
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Affiliation(s)
- Vincenzo Pinto
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Miriam Dellino
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence: (M.D.); (E.C.)
| | - Carla Mariaflavia Santarsiero
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Gennaro Cormio
- Gynecologic Oncology IRCCS Istituto Tumori “Giovanni Paolo II” Bari, 70124 Bari, Italy
- Department of Interdiscipliniary Medicine (DIM), University of Bari, 70121 Bari, Italy
| | - Vera Loizzi
- Gynecologic Oncology IRCCS Istituto Tumori “Giovanni Paolo II” Bari, 70124 Bari, Italy
- Department of Interdiscipliniary Medicine (DIM), University of Bari, 70121 Bari, Italy
| | - Valentina Griseta
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Antonella Vimercati
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Gerardo Cazzato
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian, Area (DiMePRe-J), School of Medicine, Aldo Moro University of Bari, 70100 Bari, Italy
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy
- Correspondence: (M.D.); (E.C.)
| | - Ettore Cicinelli
- Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
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