Contribution of ultrasonography to the prediction of the induction-delivery interval: The ECOLDIA prospective multicenter cohort study. - 10/07/21

Doi : 10.1016/j.jogoh.2021.102196

Chloé Arthuis ^a,^⁎ , Jérôme Potinb Norbert Winer ^a, Elsa Tavernier ^d, Julie Paternotte ^b, Anna Ramos ^c, Franck Perrotin ^b, Caroline Diguisto ^b
^a Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire Nantes, Nantes, France
^b Department of Gynecology and Obstetrics, Centre Hospitalier Régional Universitaire Tours, Tours, France
^c Department of Gynaecology and Obstetrics, Centre Hospitalier Régional d'Orléans, Orleans, France
^d Inserm CIC 1415, Centre Hospitalier Régional Universitaire Tours, Tours, France

^⁎Corresponding author: Department of Gynecology and Obstetric, University Hospital Center Nantes, 38 Bd Jean Monnet- 44000 Nantes, +330244768308Department of Gynecology and ObstetricUniversity Hospital Center Nantes38 Bd Jean Monnet- 44000Nantes

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Highlights

•	Previous studies reported contradictory results that might be explained by heterogeneous populations
•	We sought to evaluate a large population of women homogeneous for cervical status using a robust methodology. Thus, bishop score was an original inclusion criterion when selecting a population to study the prediction of induction-delivery interval.
•	It is the largest cohort of women to evaluate the induction-delivery interval.
•	Moreover, women undergoing induction of labor with a harmonized single-agent protocol in order to reduce heterogeneity of study population.
•	Transvaginal ultrasound cervical length can significantly predict induction-delivery interval with parity.

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ABSTRACT

Introduction

To evaluate the ability of preinduction ultrasonographic cervical length to predict the interval between induction and delivery in women at term with a Bishop score of 4 to 6 at induction.

Study design

This multicenter prospective observational cohort recruited 334 women from April 2010 to March 2014. Inclusion criteria were women with singleton pregnancies at a gestational age ≥37 weeks, with no previous caesarean, a medical indication for induction of labor, and a Bishop score of 4, 5, or 6. All women underwent cervical assessment by both transvaginal ultrasound and digital examination (Bishop score). The induction protocol was standardized. The primary outcome measure was the induction-delivery interval. Hazard ratios (HR) and their 95% confidence intervals (95% CI) were used to assess potential predictors.

Results

Mean gestational age at induction was 40.1 weeks, 60.8% of the women were nulliparous, and the cesarean rate was 13.4%. The mean induction-delivery interval was 20.8 h (± 10.6). Delivery occurred within 24 h for 56.9% (n=190) of the women. An ultrasonographic cervical length measurement less than 25 mm (HR=1.50, 95% CI 1.18–1.91, P<0.01) and parity (HR=1.41, 95% CI 1.21–1.65, P<0.01) appeared to predict induction-delivery interval. The cervical length cutoff to reduce the induction-delivery interval was 25 mm.