Effect of pre-induction transperineal ultrasonographic cervical lengt measurements and Bishop score on induction-to-delivery time

Öz

Objective: We aimed to evaluate the effect of preinduction cervical length and Bishop score for induction-to-delivery interval in nulliparae and multiparae. Materials and Methods: A total of 97 pregnant women (55 nulliparae, 42 multiparae) between 35 and 44 weeks of gestation were included in the study. Misoprostol 50 g tablet was used as labour induction agent intravaginally. Cervical length measurement was obtained by transperineal ultrasonographic approach and Bishop score was determined with digital examination. While Mann-Whitney U test, Pearson correlation, spearman correlation and multiple linear regressions were used for continuous variables, chi-square test was used for categorical variables. Receiver Operating Characteristics Curve was used for bishop score and cervical length. Results: All vaginal deliveries were occurred within 24 hours. Eighth patients (8.2%) had nausea, 1 had (1%) vomiting, 9 had (9.3%) tachysystoly and 5 had (5.1%) hiperstimulation. Eight pregnant women (8.2%) were delivered with caesarean section. In nulliparous and multiparous women, Bishop score and cervical length showed correlation (r=0.752, p=0.000; r=0.691, p=0.000; respectively). Cervical length (r=0.490, p=0.000) and Bishop score (r=0.455, p=0.01) were correlated in nulliparae whereas only Bishop score (r=0.441, p=0.04) were correlated in multiparae. To determine the induction-to-delivery time using multiple linear regression, the cervical length for multiparae (t=3.850, p=0.000) and the Bishop Score for multiparae (t=11.222, p=0.000) were the only independent variables. Receiver operating characteristics for induction-to-delivery time curve showed that cervix length was better than Bishop score in nulliparae whereas the Bishop Score was better than cervical length in multiparae. Conclusion: Fifty g misoprostol intravaginally was found successful in induction of delivery. To determine induction-to-delivery time in pregnancies, cervical length in nulliparae and Bishop score in multiparae was found more suitable.

Anahtar Kelimeler

• Ultrasonography,Delivery, Obstetric,Cervix Uteri,Misoprostol,Parity

İndüksiyon öncesi transperineal ultrasonografik servikal uzunluk ve Biskop skorunun indüksiyon-doğum süresine etkisi

Öz

Amaç: Nullipar ve multipar gebelerde indüksiyon öncesi ultrasonografik servikal uzunluk ve Bishop skorunun indüksiyon-doğum süresine etkisini araştırdık. Gereç ve Yöntem: Çalışmaya 35-44 gebelik haftaları arasında değişen 97 gebe (55 nullipar, 42 multipar) alındı; indüksiyon amacıyla intravaginal yoldan misoprostol 50 g tablet kullanıldı; Bishop skoru dijital muayene ile belirlendi; servikal uzunluk transperineal ultrasonografi ile ölçüldü. Sürekli değişkenler için Mann-Whitney U testi, Pearson korelasyon, Spearman korelasyon ve çoklu doğrusal regresyon kullanıldı. Kategorik değişkenler için ÷2 testi kullanıldı. Bishop skoru ve servikal uzunluk için Receiver Operating Characteristic (ROC) eğrisi çizildi. Bulgular: Bütün vaginal doğumlar 24 saat içerisinde gerçekleşti. Bulantı 8 (%8.2), kusma 1 (%1) taşisistoli 9 (%9.3), hiperstimülasyon 5 (%5.1) gebede görüldü. Sekiz olgu (%8.2) sezaryen ile doğurtuldu. Nullipar ve multipar gebelerde Bishop skoru ve servikal uzunluk (sırasıyla r=0.752, p=0.000; r=0.691, p=0.000) korelasyon gösterdi. Nullipar gebelerde indüksiyon-doğum süresi ile servikal uzunluk (r=0.490, p=0.000) ve Bishop skoru (r=0.455, p=0.01) korelasyon gösterdi, multiparlarda ise sadece Bishop skorunda (r=0.441, p=0.004) korelasyon bulundu. Çoklu doğrusal regresyon modeline göre nullipar gebelerde servikal uzunluk (t=3.850, p=0.000), multipar gebelerde ise Bishop skorunun (t=11.222, p=0.000) tek bağımsız değişken olduğu görüldü. ROC eğrisine göre nulliparlarda indüksiyon-doğum süresini belirlemede servikal uzunluğun, multiparlarda ise Bishop skorunun daha iyi olduğu bulundu. Sonuç: İntravaginal yoldan misoprostol 50 g uygulaması doğum indüksiyonunda başarılı bulundu. İndüksiyon-doğum süresini belirlemede nullipar gebelerde servikal uzunluğun, multipar gebelerde ise Bishop skorunun kullanılmasının daha uygun olduğu sonucuna varıldı.

Anahtar Kelimeler

• Ultrasonografi,Doğum, obstetrik,Serviks uteri,Misoprostol,Parite

Kaynakça

1. Gonen R, Degani S, Ron A. Prediction of successful induction of labor: comparison of transvaginal ultrasonography and the Rishop score
2. Eur J Ultrasound 1998; 7:183-187
3. Demir N. Normal Doğum. In: Reksaç MS, Demir N, Koç A, Yüksel A, eds. Obstetrik; Maternal-Fetal Tıp ve Perinatoloji. 1. bash, Ankara, Medical Network, 2001: 1258-1298
4. Norwitz ER, Robinson JN, Repke JT. Labor and delivery. In: Gabbe SG, NiebylJR, Simpson JL, eds
5. ORSTETRİCS: Normal and Problem Pregnancies
6. 4th ed. Philadelphia: Churchill Livingstone Company, 2002: 353-394
7. Gelişen O, Gültekin İR. Doğum ve Doğum Komplikasyonları. in: Beksaç MS, Öcal ŞA, Katoğlu T, Şenocak Z, Şuğle MA, eds. Doğum Hekimliği Maternal-Fetal Tıp'ta Etik ve Yasal Royut. Ankara, Medical Network, 2004: 236-251
8. The American Academy of Pediatrics and The American College of Obstetricians and Gynecologist Publication: Guidelines for Prenatal Care, 4 ed., 1997

9. Cunningham FG, Leveno KJ, Rloom SL, Hauth JC, Gilstrap IIILC, Wentsrom KD. Induction of labor
10. In: Cunningham FG, Leveno KJ, Rloom SL, Hauth JC, Gilstrap III LC, Wentsrom KD., eds. Williams Obstetrics. 22nd ed. New York: McGraw-Hill, 2005: 535-545
11. Induction of labor as compared with serial antenatal monitoring in post-term pregnancy. A randomized controlled trial. The Canadian Multicenter Post-term Pregnancy Trial Group. N Engl J Med 1992; 326:1587-1592
12. Induction of labor and the relationship to cesarean delivery: A review of 7001 consecutive inductions
13. Am J Obstet Gynecol 1999; 180:628-633
14. Dhall K, Mittal SC, Kumar A. Evaluation of preinduction scoring systems. Aust N Z J Obstet Gynaecol 1987; 27:309-311
15. Onderoglu LS. Digital examination and transperineal ultrasonographic measurement of cervical length to assess risk of preterm delivery. Int J Gynaecol Obstet 1997; 59:223-228
16. Rishop EH. Pelvic scoring for elective induction
17. Obstet Gynecol 1964; 24:266-268
18. Farah LA, Sanchez-Ramos L, Rosa C, Del Valle GO, Gaudier FL, Delke I, et al. Randomized trial of two doses of the prostaglandin El analog misoprostol for labor induction. Am J Obstet Gynecol 1997; 177:364-369
19. Pandis GK, Papageorghiou AT, Otigbah CM, Howard RJ, Nicolaides KH. Randomized study of vaginal misoprostol PGEl and dinoprostone gel PGE2 for induction of labor at term. Ultrasound Obstet Gynecol 2001; 18:629-635
20. Sanchez-Ramos L, Kaunitz AM, Delke I. Labor induction with 25 g versus 50 g intravaginal misoprostol: a systematic review. Am J Obstet Gynecol 2002; 99:145-151
21. Wing DA, RahallA, Jones MM, Goodwin TM, Paul RH. Misoprostol. An effective agent for cervical ripening and labor induction. Am J Obstet Gynecol 1995; 172:1811-1816
22. Wing DA, RahallA, Jones MM, Goodwin TM, Paul RH. A comparison of misoprostol and prostaglandin E2 gel for preinduction cervical ripening and labor induction. Am J Obstet Gynecol 1995; 172:1804-1810
23. Meydanli MM, Caliskan E, RurakF, Narin MA, Atmaca R. Labor induction post-term with 25 micrograms vs. 50 micrograms of intravaginal misoprostol. Int J Gynaecol Obstet 2003; 81:249- 255
24. Hofmeyr GJ, Gulmezoglu AM, Alfirevic Z
25. Misoprostol for induction of labour: a systematic review. Rr J Obstet Gynaecol 1999; 106:798-803
26. El-Sherbiny MT, El-Gharieb IH, Gewely HA
27. Vaginal misoprostol for induction of labor: 25 vs
28. 50 microg dose regimen. Int J Gynaecol Obstet
29. 2001; 72:25-30
30. Yenen MC, Dede M, Göktolga Ü, Güngör S
31. Doğum indüksiyonunda misoprostol ve oksitosin kullanımının karşılaştırılması. Medikal Network Klinik Bilimler ve Doktor 2003; 9:630-634
32. Sanchez-Ramos L, Danner CJ, Delke I, Kaunitz AM. The effect of tablet moistening on labor induction with intravaginal misoprostol: a randomized trial Am J Obstet Gynecol 2002; 99:1080-1084
33. Wang H, Li L, Pu L. The effect of 25 micrograms misoprostol on induction of labor in late pregnancy
34. Zhonghua Fu Chan Ke Za Zhi. 1998; 33:469-71 (Abstract)
35. Has R, Batukan C, Ermiş H, Cevher E, Araman A, Kilic G, Ibrahimoglu L. Comparison of 25 and 50 microg vaginally administered misoprostol for preinduction of cervical ripening and labor induction. Gynecol Obstet Invest. 2002; 53:16-21
36. Shetty A, Danielian P, Templeton A. A comparison of oral and vaginal misoprostol tablets in induction of labour at term. BJOG 2001; 108:238- 243
37. Kumru S, Boztosun A, Şimşek M, Sapmaz E
38. Doğum indüksiyonu için intravaginal misoprostol uygulamasınmetkinliğinin ve güvenilirliğinin araştırılması. Türkiye Klinikleri Jinekoloji Obstethk Dergisi 2004; 14:47-51
39. Pandis GK, Papageorghiou AT, Ramanathan VG, Thompson MO, Nicolaides KH. Preinduction sonographic measurement of cervical length in the prediction of successful induction of labor
40. Ultrasound Obstet Gynecol 2001; 18:623-628
41. Richey SD, Ramin KD, Roberts SW, Ramin SM, Cox SM, Twickler DM.The correlation between transperineal sonography and digital examination in the evaluation of the third-trimester cervix. Obstet Gynecol 1995; 85:745-748
42. Mahony BS, Nyberg DA, Luthy DA, Hirsch JH, HickokDE, Petty CN. Translabial ultrasound of the third-trimester uterine cervix. Correlation with digital examination. J Ultrasound Med 1990; 9:717- 723
43. Paterson-Brown S, Fisk NM, Edmonds DK, Rodeck CH. Preinduction cervical assessment by Bishop's score and transvaginal ultrasound. EurJ Obstet Gynecol Reprod Biol 1991; 40:17-23
44. Boozarjomehri F, Timor-Trirsch I, Chao CR, Fox HE. Transvaginal ultrasonographic evaluation of the cervix before labor: presence of cervical weding is associated with shorter duration of inducced labor. Am J Obstet Gynecol 1994; 171:1081-1087
45. Yang SH, Roh CR, Kim JH. Transvaginal ultrasonography for cervical assessment before induction of labor. J Ultrasound Med 2004; 23:375- 382
46. Watson WJ, Stevens D, Welter S, Day D. Factors predicting successful labor induction. Obstet Gynecol 1996; 88:990-992