Ultrasound Evaluation of the Cervix to Predict Failed Labor Induction

Abstract

Objective Labor induction does not always result in vaginal delivery, and can expose both the mother and the fetus to the risks inherent to the induction procedure or a possible cesarean section. Transvaginal sonography (TVS) of the cervix is a useful tool to predict prematurity; in the present study, this tool was used to evaluate postterm induction. Methods We evaluated the ultrasound characteristics of the cervix (cervical length, cervical funneling, internal os dilation, the presence or absence of the cervical gland area [CGA], and the morphological changes of the cervix as a result of applying fundal pressure) before the onset of labor induction among women with postterm pregnancy to identify the possible predictors of failed labor induction. The Bishop score (BS) was used for comparison purposes. Three groups were evaluated: successful versus unsuccessful induction; vaginal delivery versus cesarean delivery (excluding cases of acute fetal distress [AFD]); and vaginal delivery versus cesarean delivery (including cases of AFD). A fourth group including only the primiparous women from the three previous groups was also evaluated. Results Based on the studied characteristics and combinations of variables, a cervical length ≥ 3.0 cm and a BS ≤ 2 were the best predictors of induction failure. Conclusion Although TVS is useful for screening for induction failure, this tool should not be used as an indication for cesarean section.

Servikal uzunluğun postterm gebelikte doğum indüksiyonuna etkisi

“…In the study of Sevrin et al, labor induction was performed on 95 post-term pregnant women and 18 patients (excluding fetal complications (n = 10)) had a cesarean section due to failed induction. Among these patients, the success of labor induction was found to be less in pregnant women with a cervical length of 30 mm or more 23 .…”

Reliability of ultrasound versus digital vaginal examination in detecting cervical dilatation during labor: a diagnostic test accuracy systematic review

“…Martorelli et al also concluded that transvaginal ultrasound before the onset of labor in women with gestational age > 40 weeks might help predict failed labor induction. Still, it should not be used for performing a cesarean section [36] .…”