Comparison Of Preinduction Sonographic Cervical Length And Bishop Score İn Prediction Of Successful Vaginal Delivery After Labor İnduction With Sublingual And Vaginal Misoprostol

Yıl 2016, Cilt: 13 Sayı: 3, 107 - 111, 01.07.2016

İsmail Burak Gültekin , Ragıp Atakan Al Serap Gültekin İsmail Dölen

Öz

Aim: To analyze and compare preinduction sonographic cervical length and Bishop score in prediction of successful vaginal delivery after labor induction with sublingual and vaginal misoprostol.Material and Methods: A total of 241 women with singleton pregnancies between 37th-42nd weeks of gestation were enrolled to the study. Subjects were randomly assigned into one of two groups in regard to the route of misoprostol administration, either sublingual or sublingual with vaginal. Preinduction cervical assessments were performed with transvaginal sonographic cervical length measurement and Bishop score.Results: Sonographic cervical length, Bishop score and parity were found as independent contributors in the prediction of likelihood of delivering vaginally within 19 hours of induction. The cut-off points for prediction of successful vaginal delivery were a cervical length of 38 mm and a Bishop score of 3. Neither method had superiority over each other with sensitivities and specificities of 61.9 and 82.6 for Bishop score and 89.9 and 43.5 for cervical length, respectively. Groups were found to have similar discriminatory results in prediction of successful vaginal delivery.Conclusion: Preinduction Bishop score with higher specificity and cervical length with higher sensitivity can both be used complementary to each other in prediction of successful vaginal delivery.

Anahtar Kelimeler

Bishop score, cervical length, induction of labor, misoprostol, vaginal delivery

Sublingual ve Vajinal Misoprostol İle Doğum İndüksiyonu Sonrasında Başarılı Vajinal Doğumu Öngörmede Sonografik Servikal Uzunluk ve Bishop Skorunun Karşılaştırılması

Öz

Amaç: Sublingual and vajinal misoprostol ile doğum indüksiyonu uygulanan gebelerde başarılı vajinal doğumu öngörmede sonografik servikal uzunluk ve Bishop skorunun karşılaştırılması.Gereç ve Yöntemler: Çalışmaya 37.- 42. gestasyonel haftalar arası tekil gebeliğe sahip, toplam 241 kadın dahil edildi. Misoprostol uygulama yoluna göre sublingual veya sublingual+vajinal vakalar randomize edilerek gruplara ayrıldı. Preindüksiyon servikal değerlendirme transvajinal sonografik serviks uzunluk ölçümü ve Bishop skoru ile yapıldı.Bulgular: İndüksiyon sonrası 19 saat içerisinde vajinal doğum öngörüsünde sonografik servikal uzunluk, Bishop skoru ve paritenin bağımsız katkılarının olduğu saptandı. Başarılı vajinal doğumu öngörmede eşik değerler servikal uzunluk için 38 mm ve Bishop skoru için 3 olarak bulundu. İki metodun da birbirine üstünlüğü bulunamadı. Sensitivite ve spesifisite değerleri sırası ile Bishop skoru için 61.9 ve 82.6 ve servikal uzunluk için 89.9 ve 43.5 olarak hesaplandı. Her iki metodun eşdeğer öngörü gücüne sahip olduğu saptandı.Sonuç: Daha yüksek sensitiviteye sahip servikal uzunluk ve spesifisiteye sahip Bishop skoru başarılı vajinal doğum öngörüsünde tamamlayıcı yöntemler olarak uygulanabilir.

Anahtar Kelimeler

Bishop skoru, doğum indüksiyonu, misoprostol, servikal uzunluk, vajinal doğum.

Kaynakça

• Induction of labor. Evidence based clinical guideline, Number 9. RCOG Clinical Support Unit, London, 2001.
• W Chen, J Xue, MK Peprah, SW Wen, M Walker,Y Gao,Y Tang. A sys- tematic review and network meta-analysis comparing the use of Foley catheters, misoprostol, and dinoprostone for cervical ripening in the in- duction of labour. www.bjog.org, DOI: 10.1111/1471-0528.13456.
• Cole RA, Howie PW, Magnoughton MC. Elective induction of labor: a randomised prospective trial. Lancet 1975;1:767-770.
• Sue-A-Quan AK, Hannah ME, Cohen MM, Foster GA, Liston RM. Effect of labor inductionon rates of stillbirth and cesarean section in postterm pregnancies. CMAJ 1999;160:1145-1149.
• Dhall K, Mittal SC, Kumar A. Evaluation of preinduction scoring systems. Aust NZ J Obstet Gyneacol 1987;27:309-311.
• Goldberg AB, Greenberg MB, Darney PD. Misoprostol and pregnancy. N Engl J Med 2001;344:38–47.
• Hofmeyr GJ, Gulmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev 2010;10: CD000941.
• Burnett JE. Preinduction scoring: An objective approach to induction of labor. Obstet Gynecol 1966;28:479-489.
• Friedman EA. Labor: Clinical evaluation and management, 2nd edition. New York, Appleton-Century-Crofts, 1978.
• Pandis GK, Papageorghiou AT, Nicolaides KH. Preinduction sonographic measurement of cervical length in the preinduction of successful inducti- on of labor. Ultrasound Obstet Gynecol 2001;18:623-628.
• Holcomb W, Smeltzer JS. Cervical effacement: Variations in belief among clinicians. Obstet Gynecol 1991;78:43-47.
• Phelps JY, Higby K, Symth MH. Accuracy and intraobserver variability of simulated cervical dilatation measurements. Am J Obstet Gynecol 1995;173:942-945.
• Zillianti M, Azuaga A, Calderon F. Monitoring the effacement of uterine cervix by transperineal sonography: A new perspective. J Ultrasound Med 1995;14:719-723.
• Andersen HF. Transvaginal and transabdominal ultrasonography of the uterine cervix during pregnancy. J Clin Ultrasound 1991;19:77-80.
• Paterson-Brown S, Fisk NM, Edmonds DK, Rodeck CH. Preinduction cer- vical assessment by Bishop’s score and transvaginal ultrasound. Eur J Obstet Gynecol Reprod Biol. 1991 Jun 5;40(1):17-23.
• Boozarjomehri F, Timor-Tritsch I, Chao CR, Fox HE. Transvaginal sonog- raphic evaluation of the cervix before labor: Presence of cervical wedging is associated with shorter duration of induced labor. Am J Obstet Gyne- col 1994;171:1081-1087.
• Watson WJ, Stevens D, Welter S, Day D. Factors predicting successful labor induction. Obstet Gynecol 1996;88:990-992.
• Gonen R, Degani S, Ron A. Prediction of successful induction of labor: Comparison of transvaginal ultrasonography and the Bishop score. Eur J Ultrasound 1998;7:183-187.
• Ware V, Raynor D. Transvaginal ultrasonographic cervical measure- ment as a predictor of successful labor induction. Am J Obstet Gynecol 2000;182:1030-1032.