RSS-Feed abonnieren
DOI: 10.1055/s-0039-1677866
Using Cervical Dilation to Predict Labor Onset: A Tool for Elective Labor Induction Counseling
Funding This study was partially supported by an Expanding the Boundaries grant through Brigham and Women's Hospital.Publikationsverlauf
29. August 2018
31. Dezember 2018
Publikationsdatum:
29. Januar 2019 (online)
![](https://www.thieme-connect.de/media/ajp/201914/lookinside/thumbnails/10-1055-s-0039-1677866_180453-1.jpg)
Abstract
Objective To evaluate whether cervical dilation predicts the timing and likelihood of spontaneous labor at term.
Study Design This was a retrospective cohort of nulliparous women with singleton pregnancies who delivered at term from 2013 to 2015. Outpatient cervical examinations performed after 37 weeks and prior to labor onset were collected. Survival analysis was used to analyze time to spontaneous labor with cervical dilation as the primary predictor, modeled as continuous and categorical variables (<1 cm, 1 cm, >1 cm).
Results Our cohort included 726 women; 407 (56%) spontaneously labored, 263 (36%) were induced, and 56 (8%) had an unlabored cesarean delivery. Women with >1-cm dilation were three times more likely to spontaneously labor (adjusted hazard ratio [aHR]: 3.1; 95% confidence interval [CI]: 2.4–4) than those with <1-cm dilation. At 39 weeks, 60% of women with >1-cm dilation went into spontaneous labor as compared with only 28% of those with <1-cm dilation (aHR: 2.9; 95% CI: 2–4.4).
Conclusion In our cohort of nulliparous women at term, those with cervical dilation > 1 cm were significantly more likely to go into labor in the following week. This information can aid in counseling about elective induction of labor.
-
References
- 1 Caughey AB, Sundaram V, Kaimal AJ. , et al. Maternal and neonatal outcomes of elective induction of labor. Evid Rep Technol Assess (Full Rep) 2009; (176) 1-257
- 2 Osterman MJKS MJ. NCHS Data Brief No. 155: recent declines in induction of labor by gestational age. Centers Dis Control Prev 2014; 14 (01) 25-33
- 3 Caughey AB, Sundaram V, Kaimal AJ. , et al. Systematic review: elective induction of labor versus expectant management of pregnancy. Ann Intern Med 2009; 151 (04) 252-263
- 4 Grobman WA. Elective induction: When? Ever?. Clin Obstet Gynecol 2007; 50 (02) 537-546
- 5 Rayburn WF, Zhang J. Rising rates of labor induction: present concerns and future strategies. Obstet Gynecol 2002; 100 (01) 164-167
- 6 American College of Obstetricians and Gynecologists. Committee opinion no. 561: non-medically indicated early-term deliveries. Obstet Gynecol 2013; 121 (04) 911-915
- 7 Snowden JM, Muoto I, Darney BG. , et al. Oregon's hard-stop policy limiting elective early-term deliveries: association with obstetric procedure use and health outcomes. Obstet Gynecol 2016; 128 (06) 1389-1396
- 8 Ananth CV, Wilcox AJ, Gyamfi-Bannerman C. Obstetrical interventions for term first deliveries in the US. Paediatr Perinat Epidemiol 2013; 27 (05) 442-451
- 9 Saccone G, Berghella V. Induction of labor at full term in uncomplicated singleton gestations: a systematic review and metaanalysis of randomized controlled trials. Am J Obstet Gynecol 2015; 213 (05) 629-636
- 10 Caughey AB, Nicholson JM, Cheng YW, Lyell DJ, Washington AE. Induction of labor and cesarean delivery by gestational age. Am J Obstet Gynecol 2006; 195 (03) 700-705
- 11 Grobman WA, Rice MM, Reddy UM. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med 2018; 379 (06) 513-523
- 12 Shetty A, Burt R, Rice P, Templeton A. Women's perceptions, expectations and satisfaction with induced labour--a questionnaire-based study. Eur J Obstet Gynecol Reprod Biol 2005; 123 (01) 56-61
- 13 Zanardo V, Bertin M, Sansone L, Felice L. The adaptive psychological changes of elective induction of labor in breastfeeding women. Early Hum Dev 2017; 104: 13-16
- 14 Choosing Wisely Campaign. Ten Things Physicians and Patients Should Question. American College of Obstetricians and Gynecologists. 2016 . Available at: https://www.acog.org/-/media/Departments/Patient-Safety-and-Quality-Improvement/Choosing-WiselyOct2016.pdf?dmc=1&ts=20180217T0255163464 . Accessed February 17, 2018
- 15 Rozenberg P, Goffinet F, Hessabi M. Comparison of the Bishop score, ultrasonographically measured cervical length, and fetal fibronectin assay in predicting time until delivery and type of delivery at term. Am J Obstet Gynecol 2000; 182 (1 Pt 1): 108-113
- 16 Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol 2011; 117 (04) 805-811
- 17 Reis FM, Gervasi MT, Florio P. , et al. Prediction of successful induction of labor at term: role of clinical history, digital examination, ultrasound assessment of the cervix, and fetal fibronectin assay. Am J Obstet Gynecol 2003; 189 (05) 1361-1367
- 18 Raghuraman N, Stout MJ, Young OM. , et al. Utility of the simplified Bishop score in spontaneous labor. Am J Perinatol 2016; 33 (12) 1176-1181
- 19 Osmundson S, Ou-Yang RJ, Grobman WA. Elective induction compared with expectant management in nulliparous women with an unfavorable cervix. Obstet Gynecol 2011; 117 (03) 583-587
- 20 Donelan EA, Grobman WA, Miller ES. Association of second-trimester cervical length with prolonged pregnancy. Obstet Gynecol 2015; 126 (03) 534-538
- 21 Denison FC, Price J, Graham C, Wild S, Liston WA. Maternal obesity, length of gestation, risk of postdates pregnancy and spontaneous onset of labour at term. BJOG 2008; 115 (06) 720-725
- 22 Hermesch AC, Allshouse AA, Heyborne KD. Body mass index and the spontaneous onset of parturition. Obstet Gynecol 2016; 128 (05) 1033-1038
- 23 Oken E, Kleinman KP, Rich-Edwards J, Gillman MW. A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr 2003; 3: 6
- 24 American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol 2013; 121 (01) 210-212
- 25 Marquette GP, Hutcheon JA, Lee L. Predicting the spontaneous onset of labour in post-date pregnancies: a population-based retrospective cohort study. J Obstet Gynaecol Can 2014; 36 (05) 391-399
- 26 Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol 1964; 24: 266-268
- 27 San Román GA. Concerns regarding a validated calculator to estimate risk of cesarean delivery after an induction of labor with an unfavorable cervix. Am J Obstet Gynecol 2018; 219 (04) 421-422
- 28 Grobman WA. Predictors of induction success. Semin Perinatol 2012; 36 (05) 344-347
- 29 Alexander JM, McIntire DD, Leveno KJ. Forty weeks and beyond: pregnancy outcomes by week of gestation. Obstet Gynecol 2000; 96 (02) 291-294
- 30 Am G, Ca C, Middleton P. , et al. Induction of labour for improving birth outcomes for women at or beyond term (Review) Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 2012; (06) 1-3