Predicting the duration of induction of labour in nulliparous women. 2020

Albert Jung, and Michael Beckmann
Mater Mothers' Hospital, Queensland, Australia.

This study examined if the modified Bishops score (MBS) at the start of an induction of labour (IOL) (VE-1) or if the MBS after pharmacological/mechanical ripening (VE-2) was the better predictor of the duration of induced labour and whether there was one component of the score that was most predictive of time to delivery.The measures at VE-2 were correlated more strongly with the time to birth, than VE-1 measures. At both VE-1 and VE-2, component measures (especially position of the cervix) showed weak correlation compared to composite measures. Omitting position from the composite score resulted in a simplified modified Bishops score (sMBS) that had the highest correlation coefficients. A model comprising sMBS and 5 clinical variables explained ∼73% of the variance.The vaginal examination findings prior to an IOL do not impact how long the labour may take. A more favourable cervix ∼12 h later (measured using a 4-item composite of dilatation, length, consistency and station) predicts a quicker induced labour.Impact statementWhat is already known? Induction of labour (IOL) is a common obstetric intervention in Australia. The IOL process can be a protracted and sometimes frustrating experience for women, and it may not result in a vaginal birth. A 'failed induction' or 'failure to progress' are relatively common indications for caesarean section (CS) in this setting where, despite many hours of an oxytocin infusion, the woman does not establish or progress in the active phase of labour.What does this study add? The measures at VE-2 were correlated more strongly with the time to birth, than VE-1 measures. At both VE-1 and VE-2, component measures (especially position of the cervix) showed weak correlation compared to composite measures. Omitting position from the composite score resulted in a simplified modified Bishops score (sMBS) that had the highest correlation coefficients. A model comprising sMBS and 5 clinical variables explained ∼73% of the variance.What are the implications of these findings? It is not the initial VE that is most predictive of the duration of labour but rather the VE after cervical ripening (mechanical or pharmacological). Simplified MBS (without the component of position of cervix) is most predictive of labour duration.

UI MeSH Term Description Entries
D007743 Labor, Obstetric The repetitive uterine contraction during childbirth which is associated with the progressive dilation of the uterine cervix (CERVIX UTERI). Successful labor results in the expulsion of the FETUS and PLACENTA. Obstetric labor can be spontaneous or induced (LABOR, INDUCED). Obstetric Labor
D007751 Labor, Induced Artificially induced UTERINE CONTRACTION. Induced Labor,Induction of Labor,Labor Induced,Labor Induction,Induced, Labor,Induction, Labor,Inductions, Labor,Labor Inductions
D010120 Oxytocics Drugs that stimulate contraction of the myometrium. They are used to induce LABOR, OBSTETRIC at term, to prevent or control postpartum or postabortion hemorrhage, and to assess fetal status in high risk pregnancies. They may also be used alone or with other drugs to induce abortions (ABORTIFACIENTS). Oxytocics used clinically include the neurohypophyseal hormone OXYTOCIN and certain prostaglandins and ergot alkaloids. (From AMA Drug Evaluations, 1994, p1157) Oxytocic,Oxytocic Agent,Oxytocic Drug,Uterine Stimulant,Uterine Stimulants,Oxytocic Agents,Oxytocic Drugs,Oxytocic Effect,Oxytocic Effects,Agent, Oxytocic,Agents, Oxytocic,Drug, Oxytocic,Drugs, Oxytocic,Effect, Oxytocic,Effects, Oxytocic,Stimulant, Uterine,Stimulants, Uterine
D010298 Parity The number of offspring a female has borne. It is contrasted with GRAVIDITY, which refers to the number of pregnancies, regardless of outcome. Multiparity,Nulliparity,Primiparity,Parity Progression Ratio,Parity Progression Ratios,Ratio, Parity Progression,Ratios, Parity Progression
D011237 Predictive Value of Tests In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test; whereas, the predictive value of a negative test is the probability that the person with a negative test does not have the disease. Predictive value is related to the sensitivity and specificity of the test. Negative Predictive Value,Positive Predictive Value,Predictive Value Of Test,Predictive Values Of Tests,Negative Predictive Values,Positive Predictive Values,Predictive Value, Negative,Predictive Value, Positive
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D002584 Cervix Uteri The neck portion of the UTERUS between the lower isthmus and the VAGINA forming the cervical canal. Cervical Canal of the Uterus,Cervical Canal, Uterine,Ectocervix,Endocervical Canal,Endocervix,External Os Cervix,External Os of the Cervix,Uterine Cervical Canal,Cervix,Cervixes,Uterine Cervix,Canal, Endocervical,Canal, Uterine Cervical,Cervix, External Os,Cervix, Uterine,Endocervical Canals,Uterine Cervical Canals
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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