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CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(08): 476-484
DOI: 10.1055/s-0039-1693679
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Ultrasound Evaluation of the Cervix to Predict Failed Labor Induction

Avaliação ultrassonográfica do colo uterino na predição do insucesso na indução do parto
Christian Eric Sevrin 
1   Department of Obstetrics and Gynecology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
,
Letícia Matheuz Martorelli
1   Department of Obstetrics and Gynecology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
,
Eduardo Augusto Brosco Famá
1   Department of Obstetrics and Gynecology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
,
César Eduardo Fernandes
1   Department of Obstetrics and Gynecology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
,
Mauro Sancovski
1   Department of Obstetrics and Gynecology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
,
Emerson Oliveira
1   Department of Obstetrics and Gynecology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
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Publikationsverlauf

27. März 2019

06. Juni 2019

Publikationsdatum:
26. August 2019 (online)

   Lizenzen und Reprints

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.


 

  • References

  • 1 Lindström TM, Bennett PR. The role of nuclear factor kappa B in human labour. Reproduction 2005; 130 (05) 569-581 . Doi: 10.1530/rep.1.00197
    CrossrefPubMedGoogle Scholar
  • 2 Phillippe M. Cell-free fetal DNA, telomeres, and the spontaneous onset of parturition. Reprod Sci 2015; 22 (10) 1186-1201 . Doi: 10.1177/1933719115592714
    CrossrefPubMedGoogle Scholar
  • 3 Akin JW, Conover WB, DePriest PD. Increasing quantity of maternal immunoglobulin G in trophoblastic tissue before the onset of normal labor. Am J Obstet Gynecol 1990; 162 (05) 1154-1157 . Doi: 10.1016/0002-9378(90)90005-R
    CrossrefPubMedGoogle Scholar
  • 4 Lim S, MacIntyre DA, Lee YS. , et al. Nuclear factor kappa B activation occurs in the amnion prior to labour onset and modulates the expression of numerous labour associated genes. PLoS One 2012; 7 (04) e34707 . Doi: 10.1371/journal.pone.0034707
    CrossrefPubMedGoogle Scholar
  • 5 Biggar RJ, Poulsen G, Melbye M, Ng J, Boyd HA. Spontaneous labor onset: is it immunologically mediated?. Am J Obstet Gynecol 2010; 202 (03) 268.e1-268.e7 . Doi: 10.1016/j.ajog.2009.10.875
    CrossrefPubMedGoogle Scholar
  • 6 Hassan SS, Romero R, Tarca AL. , et al. The transcriptome of cervical ripening in human pregnancy before the onset of labor at term: identification of novel molecular functions involved in this process. J Matern Fetal Neonatal Med 2009; 22 (12) 1183-1193 . Doi: 10.3109/14767050903353216
    CrossrefPubMedGoogle Scholar
  • 7 Mandruzzato G, Alfirevic Z, Chervenak F. , et al; World Association of Perinatal Medicine. Guidelines for the management of postterm pregnancy. J Perinat Med 2010; 38 (02) 111-119 . Doi: 10.1515/JPM.2010.057
    PubMed
  • 8 American College of Obstetricians and Gynecologists. Practice bulletin no. 146: Management of late-term and postterm pregnancies. Obstet Gynecol 2014; 124 (2 Pt 1): 390-396 . Doi: 10.1097/01.AOG.0000452744.06088.48
    CrossrefPubMedGoogle Scholar
  • 9 Ramires de Jesus G, Ramires de Jesus N, Peixoto-Filho FM, Lobato G. Caesarean rates in Brazil: what is involved?. BJOG 2015; 122 (05) 606-609 . Doi: 10.1111/1471-0528.13119
    CrossrefPubMedGoogle Scholar
  • 10 Ministério da Saúde. DATASUS: Tecnologia da Informação a Serviço do SUS. Nascidos Vivos. 2017 http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sinasc/cnv/nvuf.def . Accessed July 12, 2017
    PubMed
  • 11 Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS One 2016; 11 (02) e0148343 . Doi: 10.1371/journal.pone.0148343
    CrossrefPubMedGoogle Scholar
  • 12 Machado Júnior LC, Sevrin CE, Oliveira E. , et al. Association between mode of delivery and neonatal deaths and complications in term pregnancy: a cohort study in Brazil. Minerva Pediatr 2014; 66 (02) 111-122
    PubMedGoogle Scholar
  • 13 Machado Junior LC, Sevrin CE, Oliveira Ed. , et al. [Association between mode of delivery and maternal complications in a public hospital in Greater Metropolitan São Paulo, Brazil]. Cad Saude Publica 2009; 25 (01) 124-132 . Doi: 10.1590/S0102-311×2009000100013
    CrossrefPubMedGoogle Scholar
  • 14 Zizzo AR, Kirkegaard I, Pinborg A, Ulbjerg N. Decline in stillbirths and perinatal mortality after implementation of a more aggressive induction policy in post-date pregnancies: a nationwide register study. Acta Obstet Gynecol Scand 2017; 96 (07) 862-867 . Doi: 10.1111/aogs.13113
    CrossrefPubMedGoogle Scholar
  • 15 Hussain AA, Yakoob MY, Imdad A, Bhutta ZA. Elective induction for pregnancies at or beyond 41 weeks of gestation and its impact on stillbirths: a systematic review with meta-analysis. BMC Public Health 2011; 11 (Suppl. 03) S5 . Doi: 10.1186/1471-2458-11-S3-S5
    CrossrefPubMedGoogle Scholar
  • 16 Dekker RL. Labour induction for late-term or post-term pregnancy. Women Birth 2016; 29 (04) 394-398 . Doi: 10.1016/j.wombi.2016.01.007
    CrossrefPubMedGoogle Scholar
  • 17 Davey MA, King J. Caesarean section following induction of labour in uncomplicated first births- a population-based cross-sectional analysis of 42,950 births. BMC Pregnancy Childbirth 2016; 16: 92 . Doi: 10.1186/s12884-016-0869-0
    CrossrefPubMedGoogle Scholar
  • 18 Talaulikar VS, Arulkumaran S. Failed induction of labor: strategies to improve the success rates. Obstet Gynecol Surv 2011; 66 (11) 717-728 . Doi: 10.1097/OGX.0b013e31823e0c69
    CrossrefPubMedGoogle Scholar
  • 19 Kjeldsen LL, Sindberg M, Maimburg RD. Earlier induction of labour in post term pregnancies--A historical cohort study. Midwifery 2015; 31 (05) 526-531 . Doi: 10.1016/j.midw.2015.02.003
    CrossrefPubMedGoogle Scholar
  • 20 Mayberry LJ, Gennaro S, Strange L, Williams M, De A. Maternal fatigue: implications of second stage labor nursing care. J Obstet Gynecol Neonatal Nurs 1999; 28 (02) 175-181
    CrossrefPubMedGoogle Scholar
  • 21 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet Gynecol 2014; 123 (2 Pt 1): 372-379 . Doi: 10.1097/01.AOG.0000443276.68274.cc
    CrossrefPubMedGoogle Scholar
  • 22 Brown R, Gagnon R, Delisle MF. ; MATERNAL FETAL MEDICINE COMMITTEE. Cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can 2013; 35 (12) 1115-1127 . Doi: 10.1016/S1701-2163(15)30764-7
    CrossrefPubMedGoogle Scholar
  • 23 Berghella V, Palacio M, Ness A, Alfirevic Z, Nicolaides KH, Saccone G. Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol 2017; 49 (03) 322-329 . Doi: 10.1002/uog.17388
    CrossrefPubMedGoogle Scholar
  • 24 Ezebialu IU, Eke AC, Eleje GU, Nwachukwu CE. Methods for assessing pre-induction cervical ripening. Cochrane Database Syst Rev 2015; (06) CD010762 . Doi: 10.1002/14651858.CD010762.pub2
    PubMedGoogle Scholar
  • 25 Hatfield AS, Sanchez-Ramos L, Kaunitz AM. Sonographic cervical assessment to predict the success of labor induction: a systematic review with metaanalysis. Am J Obstet Gynecol 2007; 197 (02) 186-192 . Doi: 10.1016/j.ajog.2007.04.050
    CrossrefPubMedGoogle Scholar
  • 26 Papillon-Smith J, Abenhaim HA. The role of sonographic cervical length in labor induction at term. J Clin Ultrasound 2015; 43 (01) 7-16 . Doi: 10.1002/jcu.22229
    PubMedGoogle Scholar
  • 27 Verhoeven CJ, Opmeer BC, Oei SG, Latour V, van der Post JA, Mol BW. Transvaginal sonographic assessment of cervical length and wedging for predicting outcome of labor induction at term: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2013; 42 (05) 500-508 . Doi: 10.1002/uog.12467
    CrossrefPubMedGoogle Scholar
  • 28 Kagan KO, Sonek J. How to measure cervical length. Ultrasound Obstet Gynecol 2015; 45 (03) 358-362 . Doi: 10.1002/uog.14742
    CrossrefPubMedGoogle Scholar
  • 29 Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol 1964; 24: 266-268
    PubMedGoogle Scholar