Korean J Obstet Gynecol.  2010 May;53(5):389-395. 10.5468/kjog.2010.53.5.389.

Evaluation of length, volume and gray-scale histogram of the cervix as predictors of successful induction

• Kim YH
• Kim JW
• Kim CH
• Cho MK
• Cho HY
• Cho AR
• Kang WD
• Kim SM
• Song TB

• KMID: 2273869
• DOI: http://doi.org/10.5468/kjog.2010.53.5.389

Abstract

OBJECTIVE
The aim of this study was to evaluate whether the Bishop score, length, volume and gray-scale histogram of the cervix has a predictive value of assessing the rate of success in trial of induction.
METHODS
Forty-one nulliparous patients with its Bishop score six or less were enrolled for this prospective study. All were on prostaglandin E2 (PGE2, Propess(R); Controlled Therapeutics Ltd) pessary. Three-dimensional transvaginal ultrasound scans of the cervix were performed on the ACCUVIX XQ (Medison) to measure length, volume, and gray-scale histogram. Bishop score was determined by digital examination. The successful induction was defined as the ability to achieve the active phase of labor corresponding to a cervical dilatation of > or =4 cm within 12 hours of removing the PGE2 pessary. The receiver operating characteristics (ROC) curves were also used to estimate an optimal cutoff point for the Bishop score, length, volume, and gray-scale histogram of the cervix. Logistic regression analysis was used for statistical analyses.
RESULTS
The overall successful rate of labor induction was 73.2% (30/41). Multiple logistic regression analyses demonstrated that the value of anterior lip histogram was significantly associated with the successful labor induction. ROC curve for anterior lip histogram value in predicting success of induction indicated a significant relationship with successful induction. The best cutoff value was 69.4.
CONCLUSION
The value of anterior lip histogram associates significantly with the prediction of successful induction in nulliparous women. But, Bishop score and other sonographic measurement of cervical length, volume, and posterior lip histogram have no predictive values for successful induction.

Keyword

Labor induction; Predictor; Histogram

MeSH Terms

Cervix Uteri
Dinoprostone
Female
Humans
Labor Stage, First
Lip
Lipids
Logistic Models
Pessaries
Pregnancy
Prospective Studies
Quaternary Ammonium Compounds
ROC Curve
Dinoprostone
Lipids
Quaternary Ammonium Compounds

Figure

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  Fig. 1 Ultrasonographic assessment of the uterine cervix. (A) Cervix length, (B) Histogram (anterior lip).

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  Fig. 2 Cervix volume by 3-D sonography using extended imaging virtual organ computer-aided analysis (XI VOCAL) technique.

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  Fig. 3 Receiver operating characteristic curve for anterior lip histogram value in predicting success of induction. The cutoff value is 69.4 (Area under the curve 0.785; Standard error 0.0757; z=3.765; P<0.01). AL: anterior lip.

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