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

Yıl 2005, Cilt: 36 Sayı: 3, 99 - 104, 01.04.2005

Gönül Duras Doyran İsmail Özdemir Aslı Somunkıran Özlem Kemik Gül Fuat Demirci Oğuz Yücel

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

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