الفهرس 
The Functional Anatomy of theOnly 14 pages are availabe for public view
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Abstract
Between 1990 and 2012, the overall frequency of labor induction more than doubled, rising from 9.5 to 23.3 percent and early term (in the 37th and 38th week of gestation) inductions quadrupled, rising from 2 to 8 percent over a similar period of time.
The Bishop score, since its description in 1964, remains the gold standard for assessing favorability for induction of labor. However, the preinduction ‘favorability’ of the cervix as assessed by the Bishop score is very subjective and several studies have demonstrated a poor predictive value for the outcome of induction especially in women with a low Bishop score.
Thus the aim of the present study was to assess the accuracy of transvaginal measurement of cervical length prior to induction of labor in prediction of successful induction.
The current study was conducted prospectively in Ain Shams University Maternity Hospital. 100 women with singleton term pregnancies cephalic presentation scheduled to undergo labor induction at ≥37 gestation were recruited to this study. Transabdominal ultrasonographic examination was performed .Then the length of the cervix was measured from the outer to the inner cervical os as a straight line by a transvaginal ultrasound and posterior cervical angle with fetal head was calculated by the same gynecologist.
Following this a digital vaginal examination was performed to evaluate the status of the uterine cervix and determine the Bishop score, Induction of labor was performed by inserting Dinoprostone 3 mg in the posterior vaginal fornix, repeated if needed every 6 h for up to two doses. Number of doses of prostaglandins range from 0-2 tablets, the mean number of doses of prostaglandins (± standard deviation [SD]) was 1.65 (± 0.59), when the cervix became favorable and no regular contractions were observed, amniotomy and oxytocin augmentation, starting at1 mIU/min and increasing 1 mIU every 30 min as necessary, oxytocin used range from 5-15 IU the mean IU of oxytocin were 8.74(± 3.75).
In the current study, (76%) of our 100 participants were delivered vaginally and (24%) women were delivered by CS. The mean age of our participants was 24.16 (±3.59) years, the mean BMI (kg/m2) was 25(±3.00) and the mean gestational age was 39.75(±1.29) weeks.
The mean age of patients delivered vaginally was 24.04(±3.65), the mean age of patients delivered by CS. was24.54 (±3.65), the mean BMI of patients delivered vaginally was 24.10(± 2.77), the mean BMI of patients delivered by CS. was 25.73(± 3.06).the mean gestational age of patients delivered vaginally was 39.76(± 1.29) and the mean gestational age of patients delivered by CS. was 39.71 (± 1.30).
There was no statistically significant correlation between age, gestational age and the success of labor induction (VD), however there was a statistically significant positive correlation between increased BMI and failure of labor induction (CS).
In the current study, both nulliparous and multiparous women were recruited 36 women were Primigravida and 64 women were multipara.72.2% of primigravidas delivered vaginally and 27.8% of them delivered by CS,76% of multipara delivered vaginally and 24% of them delivered by CS, There was no statistically significant correlation between parity and the success of labor induction (p value 0.507).
In the current study, induction was indicated for medical and obstetric reasons. The most common cause of induction was ROM (46females) 37 of them have delivered vaginally followed by postdate (37females) 27 of them have delivered vaginally, PIH (females) 12 of them have delivered vaginally, there was no statistically significant correlation between indications of induction and success of induction of labor (p value 0.620).
As regard neonatal outcome, in the current study, the mean fetal birth weight of babies delivered vaginally was 2786.52(± 368.25) gms and the mean fetal birth weight of babies delivered by CS. was 2775.40 (± 356.95). There was no statistically significant correlation between birth weight and the success of labor induction.
In current study the cervical length of the participants range from 14-38 mm, the mean cervical length of the participants was 25.44 (±5.80);The mean cervical length in patients delivered vaginally was 23.14 (± 4.33) mm while the mean cervical length in patients delivered by CS. was32.71 (± 3.37) mm.
There was a statistically significant positive correlation between sonographic cervical length and failure of labor induction (CS) (p value <0.001).
ROC curves were constructed for a cervical length at a cut-off of ≤ 25 mm, sensitivity and specificity for vaginal delivery were 67.1 and 87.5 percent, and diagnostic accuracy 81.0%.
In current study, the posterior cervical angle of the participants range from 42°-124°, the mean posterior cervical angle of the participants was 82.80 (±21.34) ° The mean posterior cervical angle in patients delivered vaginally was 85.58(± 21.93) °, while the mean posterior cervical angle in patients delivered by CS. was 74.00(± 16.91)°.
There was a statistically significant negative correlation between posterior cervical angle and failure of labor induction (CS) (p value 0.020).
ROC curves were constructed for a Posterior cervical angle at a cut-off of >75 degree, sensitivity and specificity for vaginal delivery were 69.7 and 70.8 percent and diagnostic accuracy 67%.
The mean Bishop score in patients delivered vaginally was 5.76(± 2.80) while the mean Bishop score in patients delivered by CS. was 3.23 (± 2.20). There was a statistically significant negative correlation between Bishop Score and failure of (CS) (p value <0.001).
ROC curves were constructed for a Bishop score at a cut-off of > 7, sensitivity and specificity for vaginal delivery were 69.7 and54.2 percent and diagnostic accuracy 66.2%.
In current study There were negative correlation between Cervical length with posterior cervical angle, as
r=-0.279 & p-value=0.005.
There was a positive correlation between cervical length and induction to delivery interval.
Positive correlation between Cervical length with Number of doses of prostaglandins, as r=0.349 & p-value<0.001.
Positive correlation between Cervical length with Birth weight, as r=0.220 & p-value=0.041.
Positive correlation between Cervical length with Augmentation by oxytocin, as r=0.302 & p-value=0.005.
Positive correlation between Posterior Cervical angle with Number of doses of prostaglandins, as r=0.230 &
p-value=0.021.
Positive correlation between Induction to delivery interval with Number of doses of prostaglandins, as r=0.831 & p-value<0.001.
Positive correlation between Inductions to delivery interval with Birth weight, as r=0.384 & p-value<0.001.
Positive correlation between Induction to delivery interval with Augmentation by oxytocin, as r=0.384 & p-value <0.001.
Positive correlation between Number of doses of prostaglandins with Birth weight, as r=0.344 & p value <0.001.
Positive correlation between Birth weight with augmentation by oxytocin, as r=0.293 & p-value=0.006.
When comparing bishop score with transvaginal ultrasound assessment of the cervix regarding cervical length and posterior cervical angle, we found that analysis of the ROC curves for cervical length, posterior cervical angle and Bishop Score indicated that all were predictors of vaginal delivery with optimal cutoffs for predicting vaginal delivery of ≤ 25mm for cervical length, PCA > 75 degree and Bishop score ≤7. Diagnostic accuracy was (81%, 67%, and 66.2% respectively) Cervical length had superior accuracy.