Doğum İndüksiyonunun başarısını öngörmede sonografik servikal uzunluk ölçümünün, Bishop skorlamasıyla karşılaştırılması
Öz
Giriş: Tüm gebeliklerin
yaklaşık % 20–30’unda doğum eylemi için indüksiyon gerekli olup, doğum indüksiyonu artmış sezaryen oranı ile
ilişkilidir. İndüksiyon başarısını
öngörmede prosedür öncesi serviksin klinik veya USG ile değerlendirilmesi
kullanılmakta ve en çok Bishop skorlaması tercih edilmektedir.
Amaç: Bu çalışmada term
gebelerde indüksiyonun başarısını göstermede sonografik servikal
uzunluk ölçümünün, Bishop skorlamasıyla karşılaştırılmasını hedefledik.
Gereç-yöntem: Bu prospektif
gözlemsel klinik çalışmada, kliniğimize başvuran, doğum indüksiyonu uygulanan 37-41
gestasyonel haftalık, uterin cerrahi öyküsü olmayan, baş prezentasyonu 126 tekil
gebe değerlendirildi. Hastanın yaşı, gestasyonel haftası, indüksiyon nedeni,
gravida, parite, tahmini fetal ağırlık, doğum şekli, Bishop skoru, sonografik
servikal uzunluk değerleri kaydedildi.
Bulgular: Bishop
skoru 5 ve altında olan grupta sezaryen (%54,8), Bishop skoru 5’in üzerinde
olan grupta ise vajinal doğum (%84,4) çoğunluktaydı. Fark analizi
sonuçlarına göre Bishop skorunun, doğum indüksiyonu başarısını göstermede
istatistiksel olarak anlamlı tanısal değerinin olduğu saptandı (p<0,001). Parite, doğum şekli, Bishop skor gruplarına göre anlamlı
farklılık göstermekteydi. Doğum şekli servikal uzunluğa göre her iki grupta da
vaginal yolla olanlar çoğunlukta bir dağılım gösterdi (sırasıyla %69,6 ve
%59,6) ve gruplar arasındaki farklar istatistiksel olarak anlamlı değildi
(p>0,05).
Parite ve vajinal doğum oranları her
iki servikal uzunluk grubunda da benzerdi. Fark analizi sonuçları ise 25 mm
değerine göre yapılan servikal uzunluk gruplarında farkların istatistiksel
olarak anlamlı olmadığını gösterdi. Servikal uzunluk ile sezaryen doğum
tahminde cut-off değeri 25 mm seçildiğinde sensivite %52,3 ve spesivite ise
%58,5 olarak bulundu.
Sonuç: Bishop skoru ve
parite başarılı bir doğum indüksiyonu için iyi prediktörler olarak bulundu.
Servikal uzunluk ölçümünün ise indüksiyon başarısını öngörmede yararı olmadığı
gösterildi.
Anahtar Kelimeler
Kaynakça
- 1. Beebe, L. A, William, F. R., Beaty, C. M, Eberly K. L., Stanley, J. R., Rayburn, L. A., Indications for Labor Induction: Differences between University and Community Hospitals, J. Reprod Med. 2000 Jun; 45(6):469-75.2. Coonrod DV, Bay RC, Kishi GY. The epidemiology of labor induction: Arizona, 1997. Am J Obstet Gynecol. 2001 Mar; 184(4):780-2.3. Calder AA: The management of the unripe cervix. In: Keirse MJNC, ABM Anderson, J Bennebroek Gravenhorst: Human Parturition. Leiden University Press, The Hague 19794. Hatfield AS, Sanchez-Ramos L, Kaunitz AM: Sonographic cervical assessment to predict the success of labor induction: A systematic review with meta- analysis. Am J Obstet Gynecol 197:186, 20075. Osterman MJ, Martin JA. Recent declines in induction of labor by gestational age. NCHS Data Brief 2014; :1.6. Kolkman DG, Verhoeven CJ, Brinkhorst SJ, et al. The Bishop score as a predictor of labor induction success: a systematic review. Am J Perinatol 2013; 30:625.7. Teixeira C, Lunet N, Rodrigues T, Barros H. The Bishop Score as a determinant of labour induction success: a systematic review and meta-analysis. Arch Gynecol Obstet 2012; 286:739.8. Gibson KS, Waters TP. Measures of success: Prediction of successful labor induction. Semin Perinatol 2015; 39:475.9. Ezebialu IU, Eke AC, Eleje GU, Nwachukwu CA. Methods for assessing preinduction cervical ripening. Cochrane Database of Systematic Reviews. 2015; 610. Khandelwal R, Patel P, Pitre D, Sheth T, Maitra N. Comparison of Cervical Length Measured by Transvaginal Ultrasonography and Bishop Score in Predicting Response to Labor Induction. J Obstet Gynaecol India. 2018;68(1):51-5711. Park KH, Kim, SN, Lee, SY, Jeong EH, Jung. JC. Comparison between sonographic cervical length and Bishop score in preinduction cervical assessment: a randomized trial. Ultrasound Obstet Gynecol 2011; 38: 198–20412. Uyar Y, Erbay G, Demir BC, Baytur Y. Comparison of the Bishop score, body mass index and transvaginal cervical length in predicting the success of labor induction. Arch Gynecol Obstet (2009) 280:357–36213. Rane SM, Pandis GK, Guirgis RR, Higgins B, Nicolaides KH. Pre-induction sonographic measurement of cervical length in prolonged pregnancy: the effect of parity in the prediction of induction-to-delivery interval. Ultrasound Obstet Gynecol. 2002; 22(1):40–44.14. Rovas L, Sladkevicius P, Strobel E, Valentin L (2005) Threedimensional power Doppler ultrasound assessment of the cervix for the prediction of successful induction of labor with prostaglandin in prolonged pregnancy. J Ultrasound Med 24(7):933–93915. Gonen R, Degani S, Ron A (1998) Prediction of successful induction of labor: comparison of transvaginal ultrasonography and the Bishop score. Eur J Ultrasound 7(3):183–187.16. Watson WJ, Stevens D, Welter S, Day D (1996) Factors predicting successful labor induction. Obstet Gynecol 88(6):990–99
Comparison of sonographic measurement of cervical length with Bishop Score to predict success rate of labor induction
Öz
Introduction: Labor induction is
imperative for 20-30% of all pregnancies, and is related to increased rate of
C-section. Evaluation of cervix manually and sonographically is commonly
preferred to predict the likelihood of the induction.
Aim: In this study, we
aimed to compare the sonographic measurement of cervical length with Bishop
score in order to infer the success rate of birth induction.
Maternal and Methods: 126 singleton
pregnancies of 37-41 weeks, with cephalic presentation and no history of
uterine surgery, were selected for birth induction and included in
this prospective observational study. Age, gestational week, the indication of
birth induction, gravidity, and parity, estimated fetal weight, delivery
method, bishop score, sonographically measured cervical length were recorded.
Results: C-section rate
(%54.8) and vaginal delivery rates (%89.4) were higher in groups with Bishop
score less than 5 and greater than five respectively; Bishop score is a
statistically significant method to foresee birth induction success.
(p<0,001). Parity and delivery method were statistically significant in
groups with different bishop score. Regarding cervical length with 25 mm cut
off, vaginal delivery was dominant in both groups, (%69,6 and 59,6
respectively) and there was no significant difference between these groups.
(p>0,05). Parity and vaginal delivery rates were similar in both groups of
cervical length. In gap analysis, there was no significant difference between 2
groups. With a cut-off point of 25 mm, the sensitivity of specificity of
cervical length was reported as 52.3% and 58.5% respectively.
Conclusion: Bishop score and parity
were favorable predictors; whereas sonographic measurement of cervical length
is an inadequate parameter to infer success rate of birth
induction.
Anahtar Kelimeler
Kaynakça
- 1. Beebe, L. A, William, F. R., Beaty, C. M, Eberly K. L., Stanley, J. R., Rayburn, L. A., Indications for Labor Induction: Differences between University and Community Hospitals, J. Reprod Med. 2000 Jun; 45(6):469-75.2. Coonrod DV, Bay RC, Kishi GY. The epidemiology of labor induction: Arizona, 1997. Am J Obstet Gynecol. 2001 Mar; 184(4):780-2.3. Calder AA: The management of the unripe cervix. In: Keirse MJNC, ABM Anderson, J Bennebroek Gravenhorst: Human Parturition. Leiden University Press, The Hague 19794. Hatfield AS, Sanchez-Ramos L, Kaunitz AM: Sonographic cervical assessment to predict the success of labor induction: A systematic review with meta- analysis. Am J Obstet Gynecol 197:186, 20075. Osterman MJ, Martin JA. Recent declines in induction of labor by gestational age. NCHS Data Brief 2014; :1.6. Kolkman DG, Verhoeven CJ, Brinkhorst SJ, et al. The Bishop score as a predictor of labor induction success: a systematic review. Am J Perinatol 2013; 30:625.7. Teixeira C, Lunet N, Rodrigues T, Barros H. The Bishop Score as a determinant of labour induction success: a systematic review and meta-analysis. Arch Gynecol Obstet 2012; 286:739.8. Gibson KS, Waters TP. Measures of success: Prediction of successful labor induction. Semin Perinatol 2015; 39:475.9. Ezebialu IU, Eke AC, Eleje GU, Nwachukwu CA. Methods for assessing preinduction cervical ripening. Cochrane Database of Systematic Reviews. 2015; 610. Khandelwal R, Patel P, Pitre D, Sheth T, Maitra N. Comparison of Cervical Length Measured by Transvaginal Ultrasonography and Bishop Score in Predicting Response to Labor Induction. J Obstet Gynaecol India. 2018;68(1):51-5711. Park KH, Kim, SN, Lee, SY, Jeong EH, Jung. JC. Comparison between sonographic cervical length and Bishop score in preinduction cervical assessment: a randomized trial. Ultrasound Obstet Gynecol 2011; 38: 198–20412. Uyar Y, Erbay G, Demir BC, Baytur Y. Comparison of the Bishop score, body mass index and transvaginal cervical length in predicting the success of labor induction. Arch Gynecol Obstet (2009) 280:357–36213. Rane SM, Pandis GK, Guirgis RR, Higgins B, Nicolaides KH. Pre-induction sonographic measurement of cervical length in prolonged pregnancy: the effect of parity in the prediction of induction-to-delivery interval. Ultrasound Obstet Gynecol. 2002; 22(1):40–44.14. Rovas L, Sladkevicius P, Strobel E, Valentin L (2005) Threedimensional power Doppler ultrasound assessment of the cervix for the prediction of successful induction of labor with prostaglandin in prolonged pregnancy. J Ultrasound Med 24(7):933–93915. Gonen R, Degani S, Ron A (1998) Prediction of successful induction of labor: comparison of transvaginal ultrasonography and the Bishop score. Eur J Ultrasound 7(3):183–187.16. Watson WJ, Stevens D, Welter S, Day D (1996) Factors predicting successful labor induction. Obstet Gynecol 88(6):990–99
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Orjinal Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Aralık 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 49 Sayı: 4 |
