Alternatives to Bishop Score for Predicting Induction Failure?
BACKGROUND AND PURPOSE:
Kamel et al. (AJOG, 2021) assessed the feasibility of developing and validating transabdominal and transperineal ultrasound for the prediction of cesarean delivery for failure to progress among women who are being induced
Prospective observational cohort study
Primigravidae | Singleton term pregnancies | Cephalic presentation
Exclusion: Operative delivery for fetal distress or indications other than failure to progress in labor
Baseline Bishop scoring
Transabdominal and transperineal ultrasound assessments of the fetus, maternal cervix, and pelvic floor
Managing obstetricians were blind to the ultrasound findings
The participants were divided into a model development group and a cross-validation group
Transabdominal scan: Fetal biometry | Fetal occiput position
Transperineal scan: Cervical length | Angle of progression (parameter for the assessment of the descent of the fetal head) AP diameter of the levator hiatus | Head-to-perineum distance | Head-to-symphysis distance
Cesarean delivery following induction for failure to progress
243 women in model development group | 101 in cross-validation group
The following were found to be independent predictive variables for cesarean delivery
Maternal age: odds ratio 1.12 (P = 0.003)
Cervical length: OR 1.08 (P = 0.04)
Angle of progression: OR 0.9 (P = 0.001)
Occiput posterior position: OR 5.7 (P = 0.006)
AUC for ability of the model to predict cesarean delivery
Developed model: 0.7969 (95% CI, 0.71 to 0.87)
Validated model: 0.88 (95% CI, 0.79 to 0.97)
This study identified a combination of maternal age and ultrasound measurements obtained during induction that were good at predicting cesarean delivery due to failure to progress following induction of labor
Digital examination can be inaccurate, especially with molding and/or caput
The authors state
On external validation, this prediction model has the potential to be a useful tool for clinicians and women to make management plans and informed healthcare choices by providing them with the individualized risk of cesarean delivery
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