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Transvaginal sonography of cervical length and Bishop score as predictors of successful induction of term labor: the effect of parity

Tan PC, Vallikkannu N, Suguna S, Quek KF, Hassan J

Clin Exp Obstet Gynecol, 2009;36(1):35-9.
PMID: 19400416

OBJECTIVE: To evaluate the predictive value for successful labor induction of transvaginal ultrasound (TVS) of cervical length according to parity.
METHOD: TVS of the cervix was performed before term labor induction. Induction was considered successful if vaginal delivery was achieved within 24 hours; 231 women were available for final analysis.
RESULTS: Analysis of the receiver operator characteristics curve showed an optimal cut-off for cervical length of < or = 20 mm for successful induction. Following multivariate logistic regression analysis, a sonographic short cervix (AOR 5.6; p < 0.001) was an independent predictor of successful induction but not a favorable Bishop score (p = 0.47). Among multiparas with a short cervix, positive and negative predictive values for successful induction were 98% (95% CI 90-100%) and 21% (95% CI 13%-32%) and among nulliparas, predictive values were 69% (95% CI 53%-82%) and 77% (95% CI 64%-87%) respectively.
CONCLUSION: In nulliparas, cervical length can usefully predict labor induction outcome.

Matched MeSH terms: Cervix Uteri/anatomy & histology*
The effects of oestradiol and relaxin on extensibility and collagen organisation of the pregnant rat cervix

Cheah SH, Ng KH, Johgalingam VT, Ragavan M

J Endocrinol, 1995 Aug;146(2):331-7.
PMID: 7561646

The effects of exogenously introduced oestradiol-17 beta (E) and relaxin (RLX) on cervical extensibility and collagen organisation were tested in rats ovariectomised in late pregnancy. When the cervices were stretched in vitro by 1 mm increments, it was found that those from rats given E alone generated significantly higher tensions than those from control rats, while cervices from rats given both E and RLX had tensions similar to controls. Examination of cervical sections under the light microscope and ultra-thin sections under the electron microscope showed that the collagen fibres in the cervices from E-treated rats were highly organised, whereas those from animals given E+RLX and control animals were disorganised and dispersed. It was concluded that E decreased cervical extensibility, while RLX counteracted the effect of E to maintain a soft and easily extensible cervix.

Matched MeSH terms: Cervix Uteri/anatomy & histology
Ultrasound and clinical predictors for Caesarean delivery after labour induction at term

Tan PC, Suguna S, Vallikkannu N, Hassan J

Aust N Z J Obstet Gynaecol, 2006 Dec;46(6):505-9.
PMID: 17116055

To assess the relationship of ultrasound assessment for amniotic fluid, fetal weight, cervical length, cervical funneling and clinical factors on the risk of Caesarean delivery after labour induction at term.

Matched MeSH terms: Cervix Uteri/anatomy & histology
Fulltext Use of the Arabin pessary in women at high risk for preterm birth: long-term experience at a single tertiary center in Malaysia

Rahman RA, Atan IK, Ali A, Kalok AM, Ismail NAM, Mahdy ZA, et al.

BMC Pregnancy Childbirth, 2021 May 10;21(1):368.
PMID: 33971828 DOI: 10.1186/s12884-021-03838-x

BACKGROUND: Spontaneous preterm birth is a global issue that contributed to perinatal morbidities and mortalities worldwide. The study aimed to describe the experience at UKM Medical Center in managing women at high risk for spontaneous preterm birth using the Arabin pessary.
METHODS: This is a retrospective observational study involving 58 pregnancies from 1st January 2013 to 31st December 2019. Inclusion criteria were previous mid-trimester miscarriage and/or preterm birth, previous cervical surgery or short cervical length on routine sonogram. The demographic data, characteristics of each pregnancy and details of outcomes and management were described.
RESULTS: The majority of women were Malay with mean age and body mass index of 32.9 ± 4.2 years and 27.1 ± 6.3 kg/m2 respectively. The most frequent indications for Arabin pessary insertion were previous mid-trimester miscarriage (46.4%) and early preterm birth (17.2%). A total of 73.4% of these women had the pessary inserted electively at a mean cervical length of 31.6 ± 9.1 mm at median gestation of 15.0 weeks. They were managed as outpatient (56.9%), inpatient (24.1%) or mixed (19.0%) with combination of progestogen (81.0%) and 53.4% received antenatal corticosteroids. Spontaneous preterm birth at or more than 34 weeks gestation occurred in 74.1% with birthweight at or more than 2000 g (82.4%). Despite cervical funneling in 12 women (20.7%), 66.7% delivered at or later than 34 weeks gestation and 2 (16.7%) resulted in miscarriage.
CONCLUSIONS: Insertion of the Arabin pessary is beneficial to prevent spontaneous preterm birth in pregnant women who are at high risk. In particular, early insertion and close monitoring allows the best possible outcomes.
TRIAL REGISTRATION: This study was retrospectively registered with ClinicalTrials.gov ( NCT04638023 ) on 20/11/2020.

Matched MeSH terms: Cervix Uteri/anatomy & histology
Transvaginal sonographic measurement of cervical length vs. Bishop score in labor induction at term: tolerability and prediction of Cesarean delivery

Tan PC, Vallikkannu N, Suguna S, Quek KF, Hassan J

Ultrasound Obstet Gynecol, 2007 May;29(5):568-73.
PMID: 17444553

To compare transvaginal sonography for cervical length measurement and digital examination for Bishop score assessment in women undergoing labor induction at term, to assess their tolerability (in terms of pain) and ability to predict need for Cesarean delivery.

Matched MeSH terms: Cervix Uteri/anatomy & histology