Preinduction Ultrasonographic Measurements as a Predictor of Successful Induction of Labour in Prolonged Pregnancy in Primigravidas
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- Category: Vol. 81, December 2013
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Preinduction Ultrasonographic Measurements as a Predictor of Successful Induction of Labour in Prolonged Pregnancy in Primigravidas, AHMED S.A. ASHOUR, RANA M.A. ABDELLA, HASSAN O. GHAREEB and FOUAD A. ABO-HAMILA
Abstract
Objective: To determine if ultrasonographic measurements as the cervical length, the fetal occiput position, the estimated fetal weight and whether the head is well flexed or not are good predictors for successful labour induction in prolonged pregnancy in primigravidas.
Design: Prospective cohort study. Setting: Kasr El-Aini Hospital.
Patients and Methods: This study included 100 primi-gravidas >!41 weeks with singleton vertex presentation, not in labour, with Bishop score !95 where previous uterine scar; previous operations on the cervix (e.g. cervical amputation); obstetric or medical complication with pregnancy (e.g. diabe-tes) were excluded. All patients were subjected to history taking, abdominal and vaginal examinations including Bishop score. The position of the occiput, estimated fetal weight and flexion of the head by abdominal ultrasonography and cervical length measurement by Transvaginal ultrasound were recorded. Labour Induction was done according to standard Kasr El Aini guidelines for induction. The primary outcome was successful attempt for vaginal delivery. Secondary outcomes were induction to delivery interval (IDI) and Apgar score at 1 and 5 minutes.
Results: In our study, there was a highly significant difference between cervical length in successful group (Mean=14.34mm) and failed group (Mean=28.25mm). There was significant difference in estimated fetal weight by ultra-sound in the successful group (Mean=3235.33gm) and failed group (Mean=3700gm). The number of cases with occipito-anterior position was higher in successful group in comparison with the failed group and the difference was statistically significant (p-value:0.0001). Flexed head position showed the highest percentage of successful labour induction in comparison with deflexed and extended positions, and the difference was statistically significant (p-value:0.002).
Conclusion: In women undergoing induction of labour, prediction of outcome can be provided by determining sono-graphically the preinduction cervical length, occipital position and degree of flexion of the head which were superior to Bishop score.