A validated calculator to estimate risk of cesarean after an induction of labor with an unfavorable cervix

Levine, Lisa D.; Downes, Katheryne; Parry, Samuel; Elovitz, Michal A.; Sammel, Mary D.; Srinivas, Sindhu K.

doi:10.1016/j.ajog.2017.11.603

Cited by 79 publications

(90 citation statements)

References 21 publications

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“…Moreover, Navve et al (28) reported that IOL in multiparous women is safe and successful regardless of the initial BS and Prado et al (35) found increased parity, increases the chance of achieving a successful VD. Recently, in a similar trial, Levine et al (3) documented that in multivariable modeling, nulliparity, BMI at delivery, and height were significantly associated with CS.…”

Section: Discussion:-mentioning

confidence: 99%

“…On contrary to these data, Silva et al (22) and Garba et al (23) found higher Bishop scores were the best predictors of successful misoprostol IOL. However, Levine et al (3) documented that modified Bishop score was significantly associated with CS.…”

Section: Discussion:-mentioning

confidence: 99%

“…Induction of labor (IOL) is a medical procedure used to initiate uterine contractions to achieve delivery (2) . Rates of IOL have increased considerably in the United States as well as around the world and have accounted for >20% of pregnancies (3) .…”

Section: …………………………………………………………………………………………………… Introduction:-mentioning

confidence: 99%

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Misoprostol Induction of Labor in Multipara Pregnant Women: A Mini-Survey for Predictors of Outcome.

MD¹,

MD²

2018

IJAR

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Objectives:To evaluate dose-related outcome of induction of labor (IOL) using misoprostol vaginal inserts (MVI) in multipara pregnant women so as to determine the appropriate dose for getting trial success defined as having vaginal delivery (VD) within 24-hr induction-todelivery (ITD) interval. Patients & Methods: 644 pregnant women underwent clinical evaluation and vaginal examination to determine Bishop score using the Simplified Bishop Score (SBS). All women received 25 µg MVI only once and were monitored for labor progress as judged by SBS and uterine contractions with fetal heart monitoring. In absence of fetal distress manifestations and membranes were still intact, but uterine contractions occurred <3 times/10 minutes, another MVI was used for a maximum of 6 doses. Uterine contraction augmentation was provided as amniotomy or/and oxytocin infusion started 4-hrs after the last MVI was placed. Study outcomes included trail success rate, number of MVI used, frequency and mode of augmentation and delivery assistance. Results: 530 women (82.3%) had VD; 159 women without augmentation, 182 women had amniotomy, 105 women received oxytocin drip and 84 women required both. Only 168 women (26.1%) had instrumentally-assisted VD. Mean ITD interval was 10.9±6.3 hr; 492 women had ITD interval <24 hr for a trial success rate of 76.4%. Cesarean section was indicted in 114 women (17.7%). Only 29 women received four, 71 three, 93 two, while 451 women received one MVI, VD rate was significantly (p<0.00001) lower among women received higher number of MVI. Statistical analyses defined high MVI dose and BMI as negative, while high parity is a positive significant predictor for trial success. High MVI dose and BMI are positive, while high SBS and high parity are negative significant predictors for long ITD interval. Kaplan-Meier regression analysis defined the appropriate MVI for IOL trial success at a mean dose of 1.5±0.039 (95% CI: 1.4-1.55). Conclusion: MVI is a satisfactory modality for IOL trial in multipara pregnant women with VD rate of 82.3% and ITD interval of <24-hr in 76.4%. Lower BMI and higher number of previous VD indicate higher possibility of trial success. SBS is appropriate for women selection for trial and follow-up and can predict outcome if combined with BMI, parity and number of MVI used.

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Section: Discussion:-mentioning

confidence: 99%

Section: Discussion:-mentioning

confidence: 99%

Section: …………………………………………………………………………………………………… Introduction:-mentioning

confidence: 99%

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Misoprostol Induction of Labor in Multipara Pregnant Women: A Mini-Survey for Predictors of Outcome.

MD¹,

MD²

2018

IJAR

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“…Caesarean section is associated with short-term and long-term complications such as postpartum haemorrhage, morbid adherence of placenta, and uterine rupture in future pregnancies [5][6][7] . Risk factors for Caesarean delivery after induction of labour include nulliparity, more advanced maternal age, greater body mass index, hypertension, and diabetes [8][9][10][11][12] . These risk factors have an overall predictive value around 70% 8,9 .…”

Section: Introductionmentioning

confidence: 99%

“…Risk factors for Caesarean delivery after induction of labour include nulliparity, more advanced maternal age, greater body mass index, hypertension, and diabetes [8][9][10][11][12] . These risk factors have an overall predictive value around 70% 8,9 . This study aimed to determine risk factors for Caesarean section after induction of labour at term among nulliparous women in Hong Kong, and to develop and validate a predictive model to help counsel women at risk of Caesarean section.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for Caesarean delivery after induction of labour among nulliparous women at term

Lee

Yeung

Leung

2020

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

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Objectives:To determine risk factors for Caesarean section after induction of labour (IOL) at term among nulliparous women, and to develop and validate a predictive model. Methods: We retrospectively reviewed records of all nulliparous women with term, singleton, cephalic pregnancies and induction of labour from 1 January to 31 December 2017 in Queen Elizabeth Hospital. The cervix was examined on admission using the Modified Bishop Score for cervical dilatation, effacement, position, consistency, fetal station. Women with unfavourable cervix received cervical priming. Those with favourable cervix proceeded to induction of labour by combining artificial rupture of membrane and oxytocin infusion. Risk factors for Caesarean delivery were identified using univariable analysis and multivariable logistic regression. A nomogram was constructed using the independent risk factors. A receiver-operating characteristics curve and the area under the curve were generated to assess the discriminative power of the predictive model. An external validation was performed. Results: A total of 1557 women who were nulliparous and had term, singleton, cephalic pregnancies and induction of labour were included for analysis. 1426 (91.6%) of them were of Chinese ethnicity. Of the 1557 women, 473 (30.4%) underwent Caesarean delivery and the remaining 1084 women delivered vaginally. In the multivariable logistic regression, independent risk factors for Caesarean delivery were maternal age (odds ratio [OR]=1.04, p=0.005), baseline height (OR=0.954, p=0.001), final body mass index (OR=1.11, p=0.001), and need for cervical priming (OR=1.32, p=0.033). The discriminative power of the predictive model was assessed by the area under the curve, which was 0.661 for the study cohort and 0.613 for the external validation set of 142 women. Conclusion: Among Hong Kong nulliparous women with induction of labour at term, independent risk factors for Caesarean delivery were older maternal age, lower baseline height, higher final body mass index, and more need for cervical priming. The predictive model based on these risk factors can calculate the probability of Caesarean section for counselling these women.

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Maternal Morbidity and Birth Satisfaction After Implementation of a Validated Calculator to Predict Cesarean Delivery During Labor Induction

et al. 2020

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A validated calculator to estimate risk of cesarean after an induction of labor with an unfavorable cervix

Cited by 79 publications

References 21 publications

Misoprostol Induction of Labor in Multipara Pregnant Women: A Mini-Survey for Predictors of Outcome.

Misoprostol Induction of Labor in Multipara Pregnant Women: A Mini-Survey for Predictors of Outcome.

Risk factors for Caesarean delivery after induction of labour among nulliparous women at term

Maternal Morbidity and Birth Satisfaction After Implementation of a Validated Calculator to Predict Cesarean Delivery During Labor Induction

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