Ultrasound examination of the cervix for predicting labor induction success: failed validation in a routine clinical setting of a successful previous pilot study

  • S. De Miguel MansoEmail author
  • C. Alvarez Colomo
  • J. Gobernado Tejedor
  • J. Schneider Fontan
  • L. Barrero Real
  • L. Martinez Ramos
Maternal-Fetal Medicine



Induction of labor (IL) involves an overload of work in hospitals, as well as increased intervention. Traditionally, the Bishop score (BS) has been used to predict the outcome of a IL, but there is a growing interest in studying the predictive capacity of ultrasound variables.


Validate a pilot predictive model performed by a single observer (Alvarez-Colomo C), based on clinical parameters and ultrasound parameters, that showed a significant association with the IL result, obtaining a correct prediction of vaginal delivery in 82.8%, with 15% false positive (FP). This validation was carried out under the usual conditions of clinical practice by four observers without distinction.


A prospective, observational study was conducted between September 2010–July 2012, recruiting 231 single pregnancies (Group 2), who were to initiate the IL process, according to the methodology and inclusion criteria of the Alvarez-Colomo study (Group 1151 patients). The outcome variable was the method of delivery.


Only fetal head–perineal distance (FHPD), cervical length (CL) and BS showed significant association with the result of IL. After applying the logistic regression equation of the pilot study, the model developed by these four observers reached a predictive capacity of 70.74% (FP = 20%). Clinical characteristics were similar in both groups. Statistically significant differences were found between the two groups for: FHPD, posterior cervical angle (PCA) and funnel existence.


It has not been possible to validate the mathematical model of Alvarez’s study in the daily conditions of clinical practice, probably due to differences in the ultrasound measurement of FHPD.


Validation pilot study Bishop score Cervical length Fetal head–perineal distance Prediction success induction of labor 


Authors’ contribution

SMM contributed to protocol/project development, data collection or management, data analysis and manuscript writing/editing. CAC contributed to protocol/project development and data collection or management. JGT contributed to data analysis and manuscript writing/editing. JSF contributed to manuscript writing/editing. LBR contributed to data collection or management. LMR contributed to data collection or management.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.


  1. 1.
    Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P (2018) Births: final data for 2016. Natl Vital Stat Rep 67(1):1–55PubMedPubMedCentralGoogle Scholar
  2. 2.
    National Collaborating Centre for Women’sand Children’s Health (2008) Induction of labour. National Institute for Health and Clinical Excellence, LondonGoogle Scholar
  3. 3.
    Kolkman DG, Verhoeven CJ, Brinkhorst SJ, van der Post JA, Pajkrt E, Opmeer BC, Mol BW (2013) The Bishop score as a predictor of labor induction success: a systematic review. Am J Perinatol 30(8):625–630CrossRefGoogle Scholar
  4. 4.
    Roman H, Verspyck E, Vercoustre L, Degre S, Col JY, Firmin JM, Caron P, Marpeau L (2004) Does ultrasound examination when the cervix is unfavorable improve the prediction of failed labor induction? Ultrasound Obstet Gynecol 23(4):357–362CrossRefGoogle Scholar
  5. 5.
    Paterson-Brown S, Fisk NM, Edmonds DK, Rodeck CH (1991) Preinduction cervical assessment by Bishop’s score and transvaginal ultrasound. Eur J Obstet Gynecol Reprod Biol 40(1):17–23CrossRefGoogle Scholar
  6. 6.
    Eggebo TM, Gjessing LK, Heien C, Swedvig E, Okland I, Romundstad P et al (2006) Prediction of labor and delivery by transperineal ultrasound in pregnancies with prelabor rupture of membranes at term. Ultrasound Obstet Gynecol 27(4):387–391CrossRefGoogle Scholar
  7. 7.
    Eggebo TM, Okland I, Heien C, Gjessing LK, Romunstand P, Salvesen KA (2009) Can ultrasound measurements replace digitally assessed elements of the Bishop score? Acta Obstet Gynecol Scand 88(3):325–331CrossRefGoogle Scholar
  8. 8.
    Sieroszewski P, Banach R (2010) Comparison of the predictive value of digital examination (Bishop’s score) and ultrasound evaluation for labor induction success. Ginekol Pol 81(2):105–110PubMedGoogle Scholar
  9. 9.
    Keepanasseril A, Suri V, Baga R, Aggarwal N (2007) Pre-induction sonographic assessment of the cervix in the prediction of successful induction of labour in nulliparous women. Aust N Z J Obstet Gynaecol 47(5):389–393CrossRefGoogle Scholar
  10. 10.
    Bajpai N, Bhakta R, Kumar P, Rai L, Hebbar S (2015) Manipal cervical scoring system by transvaginal ultrasound in predicting successful labour induction. J Clin Diagn Res 9(5):QC04-9PubMedGoogle Scholar
  11. 11.
    Pitarello Pda R, Tadashi Yoshizaki C, Ruano R, Zugaib M (2013) Prediction of successful labor induction using transvaginal sonographic cervical measurements. J Clin Ultrasound 41(2):76–83CrossRefGoogle Scholar
  12. 12.
    Prado CA, Araujo Junior E, Duarte G, Quintana SM, Tonni G, Cavalli Rde C, Marcolin AC (2016) Predicting success of labor induction in singleton term pregnancies by combining maternal and ultrasound variables. J Matern Fetal Neonatal Med 29(21):3511–3518PubMedGoogle Scholar
  13. 13.
    Fruscalzo A, Londero AP, Fröhlich C, Meyer-Wittkopf M, Schmitz R (2015) Quantitative elastography of the cervix for predicting labor induction success. Ultraschall Med 36(1):65–73PubMedGoogle Scholar
  14. 14.
    Torkildsen EA, Salvesen KA, Eggebo TM (2011) Prediction of delivery mode with transperineal ultrasound in women with prolonged first stage of labor. Ultrasound Obstet Gynecol 37(6):702–708CrossRefGoogle Scholar
  15. 15.
    Kehila M, Bougmiza I, Ben Hmid R, Abdelfatteh W, Mahjoub S, Channoufi MB (2015) Bishop score vs. ultrasound cervical length in the prediction of cervical ripening success and vaginal delivery in nulliparous women. Minerva Ginecol 67(6):499–505PubMedGoogle Scholar
  16. 16.
    Gomez Laencina AM, Sanchez FG, Gimenez JH, Martinez MS, Valverde Martinez JA, Vizcaino VM (2007) Comparison of ultrasonographic cervical length and the Bishop score in predicting successful labor induction. Acta Obstet Gynecol Scand 86(7):799–804CrossRefGoogle Scholar
  17. 17.
    Elghorori MRM, Hassan I, Dartey W, Abdel-Aziz E, Bradley M (2006) Comparison between subjective and objective assessments of the cervix before induction of labour. J Obstet Gynaecol 26(6):521–526CrossRefGoogle Scholar
  18. 18.
    Álvarez-Colomo C, Gobernado-Tejedor JA (2016) The validity of ultrasonography in predicting the outcomes of labour induction. Arch Gynecol Obstet 293(2):311–316CrossRefGoogle Scholar
  19. 19.
    Valentin L, Bergelin I (2002) Intra- and interobserver reproducibility of ultrasound measurements of cervical length and width in the second and third trimesters of pregnancy. Ultrasound Obstet Gynecol 20(3):256–262CrossRefGoogle Scholar
  20. 20.
    Rane SM, Guirgis RR, Higgins B, Nicolaides KH (2004) The value of ultrasound in the prediction of successful induction of labor. Ultrasound Obstet Gynecol 24(5):538–549CrossRefGoogle Scholar
  21. 21.
    Gabriel R, Darnaud T, Chalot F, Gonzalez N, Leymarie F, Quereux C (2002) Transvaginal sonography of the uterine cervix prior to labor induction. Ultrasound Obstet Gynecol 19(3):254–257CrossRefGoogle Scholar
  22. 22.
    Yanik A, Gülümser C, Tosun M (2007) Ultrasonographic measurement of cervical length in predicting mode of delivery after oxytocin induction. Adv Ther 24(4):748–756CrossRefGoogle Scholar
  23. 23.
    Daskalakis G, Thomakos N, Hatziioannou L, Mesogitis S, Papantoniou N, Antsaklis A (2006) Sonographic cervical length measurement before labor induction in term nulliparous. Fetal Diagn Ther 21(1):34–38CrossRefGoogle Scholar
  24. 24.
    Ivars J, Garabedian C, Devos P, Therby D, Carlier S, Deruelle P, Subtil D (2016) Simplified Bishop score including parity predicts successful induction of labor. Eur J Obstet Gynecol Reprod Biol 203:309–314CrossRefGoogle Scholar
  25. 25.
    Hiersch L, Borovich A, Gabbay-Benziv R, Maimon-Cohen M, Aviram A, Yogev Y, Ashwal E (2017) Can we predict successful cervical ripening with prostaglandin E2 vaginal inserts? Arch Gynecol Obstet 295(2):343–349CrossRefGoogle Scholar
  26. 26.
    Meier K, Parrish J, D’Souza R (2019) Prediction models for determining the success of labor induction: a systematic review. Acta Obstet Gynecol Scand 22:1–13Google Scholar
  27. 27.
    Levine LD, Downes KL, Parry S, Elovitz MA, Sammel MD, Srinivas SK (2018) A validated calculator to estimate risk of cesarean after an induction of labor with an unfavorable cervix. Am J Obstet Gynecol 218(2):254.e1–254.e7CrossRefGoogle Scholar
  28. 28.
    Alavifard S, Meier K, D’Souza R (2018) Prediction calculator for induction of labor: no Holy Grail yet! Am J Obstet Gynecol 219(4):419–420CrossRefGoogle Scholar
  29. 29.
    Hertzberg BS, Kliewer MA, Baumeiser LA, McNally PB, Fazekas CK (1994) Optimizing transperineal sonographic imaging of the cervix: the hip elevation technique. J Ultrasound Med 13(12):933–936CrossRefGoogle Scholar
  30. 30.
    Benediktsdottir S, Salvesen KÅ, Hjartardottir H, Eggebø TM (2018) Reproducibility and acceptability of ultrasound measurements of head-perineum distance. Acta Obstet Gynecol Scand 97(1):97–103CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyUniversitary Clinic HospitalValladolidSpain
  2. 2.University of MedicineValladolidSpain

Personalised recommendations