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Kim, Kim, Kim, Cho, Cho, Cho, Kang, Kim, and Song: Evaluation of length, volume and gray-scale histogram of the cervix as predictors of successful induction
Original Article
Korean Journal of Obstetrics and Gynecology

Korean Journal of Obstetrics and Gynecology 2010; 53(5): 389-395.

Published online: 31 May 2010

DOI: https://doi.org/10.5468/kjog.2010.53.5.389

Evaluation of length, volume and gray-scale histogram of the cervix as predictors of successful induction

Yoon Ha Kim, M.D., Jong Woon Kim, M.D., Chul Hong Kim, M.D., Moon Kyoung Cho, M.D., Hye Yon Cho, M.D., Ah-Ra Cho, M.D., Woo Dae Kang, M.D., Seok Mo Kim, M.D., Tae-Bok Song, M.D.

Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.

Corresponding author (kimyh@chonnam.ac.kr)

Received 21 March 2010       Accepted 19 April 2010

Copyright © 2010 Korean Society of Obstetrics and Gynecology

Abstract

Objective

The aim of this study was to evaluate whether the Bishop score, length, volume and gray-scale histogram of the cervix has a predictive value of assessing the rate of success in trial of induction.

Methods

Forty-one nulliparous patients with its Bishop score six or less were enrolled for this prospective study. All were on prostaglandin E2 (PGE2, Propess®; Controlled Therapeutics Ltd) pessary. Three-dimensional transvaginal ultrasound scans of the cervix were performed on the ACCUVIX XQ (Medison) to measure length, volume, and gray-scale histogram. Bishop score was determined by digital examination. The successful induction was defined as the ability to achieve the active phase of labor corresponding to a cervical dilatation of ≥4 cm within 12 hours of removing the PGE2 pessary. The receiver operating characteristics (ROC) curves were also used to estimate an optimal cutoff point for the Bishop score, length, volume, and gray-scale histogram of the cervix. Logistic regression analysis was used for statistical analyses.

Results

The overall successful rate of labor induction was 73.2% (30/41). Multiple logistic regression analyses demonstrated that the value of anterior lip histogram was significantly associated with the successful labor induction. ROC curve for anterior lip histogram value in predicting success of induction indicated a significant relationship with successful induction. The best cutoff value was 69.4.

Conclusion

The value of anterior lip histogram associates significantly with the prediction of successful induction in nulliparous women. But, Bishop score and other sonographic measurement of cervical length, volume, and posterior lip histogram have no predictive values for successful induction.

Keywords: Labor induction, Predictor, Histogram

Figures and Tables

Fig. 1
Ultrasonographic assessment of the uterine cervix. (A) Cervix length, (B) Histogram (anterior lip).
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Fig. 2
Cervix volume by 3-D sonography using extended imaging virtual organ computer-aided analysis (XI VOCAL) technique.
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Fig. 3
Receiver operating characteristic curve for anterior lip histogram value in predicting success of induction. The cutoff value is 69.4 (Area under the curve 0.785; Standard error 0.0757; z=3.765; P<0.01). AL: anterior lip.
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Table 1
Bishop score and ultrasonographic assessment values
kjog-53-389-i001

Data are expressed as the means±standard deviations (SD).

Table 2
The clinical characteristics and pregnancy outcomes
kjog-53-389-i002

Data are expressed as the means±standard deviations (SD).

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