Cervical and Lower Uterine Parameter Ultrasound and Elastographic Parameters for the Prediction of a Successful Induction of Labor

Abstract

Purpose The prediction of successful induction of labor (IOL) has been the subject of a series of studies. The predictive role of cervical sonographic and elastographic parameters has been controversially discussed. Lower uterine segment (LUS) thickness and strain values have not been discussed yet in this regard.

Materials and Methods A prospective cohort study was performed to examine the predictive power of Bishop score parameters, sonographic cervical length (CL), cervical funneling, cervical strain values, LUS thickness and its strain values regarding successful IOL within 24 hours and intervals to onset of labor, ROM and delivery of the fetus. A p-value of < 0.05 was considered statistically significant.

Results 135 patients were examined. A cervical length of 25 mm, the presence of cervical funneling and digital shorter cervix was significant for the prediction of successful induction of labor (IOL) within 24 hours. There was weak correlation between the functional CL and the onset of labor (r² = 0.10) and ROM (r² = 0.13). There was also a weak correlation between the cervical funnel width and the time interval to the onset of labor (r² = 0.25), ROM (r² = 0.23) and delivery of the fetus (r² = 0.22). Cervical elastography, LUS thickness and strain values were not significant for the prediction of a successful IOL.

Conclusion We were able to show that cervical structural changes at the level of the internal os, i. e., shortening through funneling, may be the determining factor for successful IOL.

Zusamenfassung

Ziel Die Prädiktion einer erfolgreichen Geburtseinleitung („induction of labor“, IOL) war Gegenstand einer Reihe von Studien. Der prädiktive Wert von sonografischen und elastografischen Parametern der Zervix wurde kontrovers diskutiert. Dicke und Strainwerte des unteren Uterinsegments (LUS) wurden in diesem Zusammenhang noch nicht diskutiert.

Material und Methoden Eine prospektive Kohortenstudie wurde durchgeführt, um die Vorhersagekraft der Bishop-Score-Parameter, der sonografischen Zervixlänge (CL), des Zervixtrichters, der zervikalen Strainwerte, der LUS-Dicke und ihrer Strainwerte in Bezug auf eine erfolgreiche IOL innerhalb von 24 Stunden und auf die Intervalle bis zum Einsetzen der Wehen, zur ROM und zur Geburt zu untersuchen. Ein p-Wert von < 0,05 war statistisch signifikant.

Ergebnisse Es wurden 135 Patienten untersucht. Eine Zervixlänge von 25 mm, das Vorhandensein des Zervixtrichters und einer digital kürzeren Zervix waren signifikant für die Vorhersage einer erfolgreichen Einleitung der Wehen (IOL) innerhalb von 24 Stunden. Eine schwache Korrelation gab es zwischen der funktionellen CL und dem Einsetzen der Wehen (r² = 0,10) und der ROM (r² = 0,13). Es bestand auch eine schwache Korrelation zwischen der Breite des Zervixtrichters und dem Zeitintervall bis zum Einsetzen der Wehen (r² = 0,25), der ROM (r² = 0,23) und der Entbindung (r² = 0,22). Die zervikale Elastografie, LUS-Dicke und Strainwerte waren nicht signifikant für die Vorhersage einer erfolgreichen IOL.

Schlussfolgerung Wir konnten zeigen, dass zervikale Strukturveränderungen im Bereich des inneren Muttermundes, d. h. die Verkürzung durch Trichterbildung, der entscheidende Faktor für eine erfolgreiche IOL sein können.

Key words

elastography - lower uterine segment - induction of labor - ultrasound

Publication History

Received: 29 July 2019

Accepted: 14 February 2020

Article published online:
20 March 2020

• References

• 1 Kim H, Hwang HS. Elastographic measurement of the cervix during pregnancy: Current status and future challenges. Obstetrics & gynecology science 2017; 60: 1-7 DOI: 10.5468/ogs.2017.60.1.1.
• 2 Vrouenraets FP, Roumen FJ, Dehing CJ. et al. Bishop score and risk of cesarean delivery after induction of labor in nulliparous women. Obstetrics & Gynecology 2005; 105: 690-697
• 3 Bishop EH. Pelvic scoring for elective induction. Obstetrics & Gynecology 1964; 24: 266-268
• 4 Pandis G, Papageorghiou A, Ramanathan V. et al. Preinduction sonographic measurement of cervical length in the prediction of successful induction of labor. Ultrasound in obstetrics & gynecology 2001; 18: 623-628
• 5 Ware V, Raynor BD. Transvaginal ultrasonographic cervical measurement as a predictor of successful labor induction. American journal of obstetrics and gynecology 2000; 182: 1030-1032
• 6 Boozarjomehri F, Timor-Tritsch I, Chao CR. et al. Transvaginal ultrasonographic evaluation of the cervix before labor: presence of cervical wedging is associated with shorter duration of induced labor. American journal of obstetrics and gynecology 1994; 171: 1081-1087
• 7 Ophir J, Cespedes I, Ponnekanti H. et al. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrasonic imaging 1991; 13: 111-134
• 8 Meyberg-Solomayer G, Gerlinger C, Hamza A. et al. Cervical Strain Elastography in Pregnancy and Association with Maternal Factors. Ultraschall in Med 2015; (1): 71-77
• 9 Hernandez-Andrade E, Hassan SS, Ahn H. et al. Evaluation of cervical stiffness during pregnancy using semiquantitative ultrasound elastography. Ultrasound in Obstetrics & Gynecology 2013; 41: 152-161
• 10 Hwang HS, Sohn IS, Kwon HS. Imaging analysis of cervical elastography for prediction of successful induction of labor at term. Journal of Ultrasound in Medicine 2013; 32: 937-946
• 11 Molina F, Gomez L, Florido J. et al. Quantification of cervical elastography: a reproducibility study. Ultrasound in Obstetrics & Gynecology 2012; 39: 685-689
• 12 Hee L, Rasmussen CK, Schlütter JM. et al. Quantitative sonoelastography of the uterine cervix prior to induction of labor as a predictor of cervical dilation time. Acta obstetricia et gynecologica Scandinavica 2014; 93: 684-690
• 13 Pereira S, Frick AP, Poon LC. et al. Successful induction of labor: prediction by preinduction cervical length, angle of progression and cervical elastography. Ultrasound in Obstetrics & Gynecology 2014; 44: 468-475
• 14 Fruscalzo A, Schmitz R, Klockenbusch W. et al. Reliability of cervix elastography in the late first and second trimester of pregnancy. Ultraschall in Med 2012; 33: E101-E107
• 15 Fruscalzo A, Steinhard J, Londero AP. et al. Reliability of quantitative elastography of the uterine cervix in at-term pregnancies. Journal of perinatal medicine 2013; 41: 421-427
• 16 Swiatkowska-Freund M, Preis K. Elastography of the uterine cervix: implications for success of induction of labor. Ultrasound in Obstetrics & Gynecology 2011; 38: 52-56
• 17 Wendell-Smith C. The lower uterine segment. BJOG: An International Journal of Obstetrics & Gynaecology 1954; 61: 87-93
• 18 Danforth D, Ivy A. The lower uterine segment. American Journal of Obstetrics & Gynecology 1949; 57: 831-841
• 19 Kearns P. The Lower Uterine Segment: Anatomical Changes During Pregnancy and Labour. Canadian Medical Association journal 1942; 46: 19
• 20 Buhimschi CS, Buhimschi IA, Malinow AM. et al. Myometrial thickness during human labor and immediately post partum. American journal of obstetrics and gynecology 2003; 188: 553-559
• 21 Buhimschi CS, Buhimschi IA, Norwitz ER. et al. Sonographic myometrial thickness predicts the latency interval of women with preterm premature rupture of the membranes and oligohydramnios. American journal of obstetrics and gynecology 2005; 193: 762-770
• 22 Sfakianaki AK, Buhimschi IA, Pettker CM. et al. Ultrasonographic evaluation of myometrial thickness in twin pregnancies. American journal of obstetrics and gynecology 2008; 198: 530. e531-530. e510
• 23 Jastrow N, Vikhareva O, Gauthier RJ. et al. Third trimester assessment of the uterine scar in women with prior caesarean: what is the evidence?. Ultrasound in Obstetrics & Gynecology 2015; 47: 410-414
• 24 Buhimschi CS, Buhimschi IA, Wehrum MJ. et al. Ultrasonographic evaluation of myometrial thickness and prediction of a successful external cephalic version. Obstetrics & Gynecology 2011; 118: 913-920
• 25 Bishop EH. Pelvic scoring for elective induction. Obstetrics and gynecology 1964; 24: 266-268
• 26 Berghella V, Berghella M. Cervical length assessment by ultrasound. Acta Obstet Gynecol Scand 2005; 84: 543-544 DOI: 10.1111/j.0001-6349.2005.00789.x.
• 27 Berghella V, Kuhlman K, Weiner S. et al Cervical funneling: sonographic criteria predictive of preterm delivery. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 1997; 10: 161-166 DOI: 10.1046/j.1469-0705.1997.10030161.x.
• 28 Ginsberg Y, Goldstein I, Lowenstein L. et al Measurements of the lower uterine segment during gestation. Journal of clinical ultrasound: JCU 2013; 41: 214-217 DOI: 10.1002/jcu.22023.
• 29 Zhang J, Landy HJ, Branch DW. et al Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstetrics and gynecology 2010; 116: 1281-1287 DOI: 10.1097/AOG.0b013e3181fdef6e.
• 30 Verhoeven CJ, Opmeer BC, Oei SG. et al Transvaginal sonographic assessment of cervical length and wedging for predicting outcome of labor induction at term: a systematic review and meta-analysis. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2013; 42: 500-508 DOI: 10.1002/uog.12467.
• 31 Al-Adwy AM, Sobh SM, Belal DS. et al Diagnostic accuracy of posterior cervical angle and cervical length in the prediction of successful induction of labor. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2018; 141: 102-107 DOI: 10.1002/ijgo.12425.
• 32 Hatfield AS, Sanchez-Ramos L, Kaunitz AM. Sonographic cervical assessment to predict the success of labor induction: a systematic review with metaanalysis. Am J Obstet Gynecol 2007; 197: 186-192 DOI: 10.1016/j.ajog.2007.04.050.
• 33 Gultekin S, Gultekin IB, Icer B. et al Comparison of elastosonography and digital examination of cervix for consistency to predict successful vaginal delivery after induction of labor with oxytocin. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet 2017; 30: 2795-2799 DOI: 10.1080/14767058.2016.1263296.
• 34 Bartolucci L, Hill WC, Katz M. et al. Ultrasonography in preterm labor. Am J Obstet Gynecol 1984; 149: 52-56