TVS assessment of cervix better predictor of successful labor induction compared to Bishop's score: Study
Induction of labor refers to stimulation of uterine contractions after the period of viability, before spontaneous onset of labor, in cases where the ongoing pregnancy may affect the mother or the fetus adversely, with the aim of vaginal delivery. The most common indications for induction of labor are post dated pregnancy, hypertensive disorders of pregnancy, oligohydramnios, PROM, etc.
It is a common practice in modern obstetrics in view of various obstetrical or medical indications. Usually, the decision to induce labor is made after considering the risk and benefits of prolonging the pregnancy. Successful induction results in vaginal delivery. However, the process is not completely seamless. Failure of induction can lead to cesarean section and the associated risks. It is therefore important to predict the chances of success of induction.
Efforts have been made to predict the rate of success of induction. Currently the most popular and widely used method is the Bishop’s score. It is a quantifiable but subjective method. Hence assessment is likely to vary from observer to observer. So the search for better predictors continues.
Trans-vaginal sonography (TVS) is an alternative but objective method emerging for assessing the cervix to predict the success of induction of labor by reducing interobserver variations. TVS measurements are quantitative and easy to reproduce, with minimal discomfort to the patient. It also allows a better evaluation of cervical length, since the supra-vaginal part of cervix is difficult to measure digitally. It also provides access to internal os, which cannot be reached in a closed cervix and where the effacement begins. Various parameters that can be used for cervical evaluation using TVS are cervical length, cervical funneling, cervical position, posterior cervical angle, distance of presenting part from external os, uterocervical angle, etc. Although many studies have been conducted to compare the Bishop’s score with TVS cervical evaluation, the superiority of one method over the other has not been clearly defined. In addition, there is a lack of definite and established cut offs to use TVS assessment in defining the success of induction. Some researchers have attempted to develop cut offs and scores to use the TVS assessment. However, these scores are not widely used at present. This might be because they used the parameters that are not easy to measure.
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