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.

Resumo

Objetivo Nem sempre a indução do parto termina em parto vaginal, expondo tanto a mãe quanto o feto aos riscos inerentes ao procedimento de indução, ou a uma possível cesárea. A ultrassonografia transvaginal (UTV) se mostrou interessante instrumento na predição da prematuridade e, neste estudo, utilizamos este instrumento na situação inversa: indução do parto no pós-datismo.

Métodos Avaliamos variáveis ultrassonográficas do colo uterino (comprimento, presença de afunilamento, dilatação do orifício interno do colo, eco glandular endocervical [EGE] evidente ou não, e alterações morfológicas do colo uterino à compressão fúndica uterina) antes do início da indução em gestantes com pós-datismo, na tentativa de encontrar um possível preditor de falha de indução. O índice de Bishop (IB) também foi utilizado para fins de comparação. Três grupos foram avaliados: indução bem-sucedida x malsucedida; parto vaginal x cesárea (excluindo casos de sofrimento fetal agudo[SFA]); e parto vaginal x cesárea (incluindo casos de SFA). Além disso, um quarto grupo composto apenas pelas primíparas dos outros três grupos também foi avaliado.

Resultados Com base em todas as características estudadas e combinações de variáveis, o comprimento do colo uterino ≥ 3,0 cm e IB ≤ 2 foram os melhores preditores em todos os grupos analisados.

Conclusão Apesar de a UTV do colo uterino ser um bom exame para rastreamento de indução malsucedida, não deve ser usado para se indicar uma cesariana.

Keywords

cervix uteri - endosonography - obstetric delivery - induced labor - prolonged pregnancy

Palavras-chave

colo do útero - endossonografia - parto obstétrico - trabalho de parto induzido - gravidez prolongada

Contributors

Christian E Sevrin: design, data collection, statistical analysis and preparation of the manuscript; Letícia M Martorelli: data collection; Eduardo A B Famá: data collection; César E Fernandes: preparation of the manuscript; Mauro Sancovski: preparation of the manuscript; and Emerson Oliveira: design, statistical analysis and preparation of the manuscript.

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