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Labour induction at term: clinical, biophysical and molecular predictive factors

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The aim of this multicentric study is to compare clinical, biophysical and molecular parameters in the prediction of the success of labour induction with prostaglandins.

Methods

We included 115 women, who underwent to labour induction at term with vaginal prostaglandin gel. We evaluated the diagnostic efficiency of endocervical phosphorylated insulin-like growth factor-binding protein (phIGFBP-1), cervicovaginal interleukins 6 (IL-6) and 8 (IL-8). We analyzed the transvaginal sonographic measurement of cervical length. A receiver-operating characteristics (ROC) curve was used to determine the most useful cut-off point. A multivariate logistic regression model was used to analyze the combination of significant predictive variables following univariate analysis. We analyzed all the data searching for the parameters that best predict the beginning of the active phase of labour within 12 h.

Results

36.5 % of the patients delivered within 12 h. The Bishop score was >4 in the 43 % of patients with an active phase. The best cut-off values at ROC curves for cervical length, IL-6 and IL-8 were respectively 22 mm, 5 mg/dl and 20,237 mg/dl. At univariate analysis, all predictors of success, with the exception of IL-6, were significantly associated with the beginning of the active phase. Multivariate analysis of the Bishop score (OR 2.3), phIGFBP-1 test (OR 11.2) and IL-8 (OR 6.6) showed that the variables were independent and therefore useful in combination to predict the success of labour induction.

Conclusion

The phIGFBP-1 test is a fast and easy test that can be used with Bishop score and IL-8 to reach an high positive predictive value in the prediction of the success of labour induction with prostaglandins.

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Abbreviations

phIGFBP-1:

Phosphorylated insulin-like growth factor-binding protein

IL:

Interleukin

PPV:

Positive predictive value

NPV:

Negative predictive value

NS:

Not significant

OR:

Odds ratio

References

  1. Cunningham GF, Gant NF, Leveno KJ et al (2001) Williams’ obstetrics. McGraw-Hill Medical Publishing Division, New York, pp 470–471

  2. Goffinet F, Humbert R, Clerson P et al (1999) National survey on the use of induced labour by ostetricians. Study groups on induced labour. J Gynecol Obstet Biol Reprod 28:319–329

    CAS  Google Scholar 

  3. American College of Obstetricians and Gynecologists (1999) Induction of labour. Practice Bulletin, The College, Washington DC

  4. Berland M (1997) Induzione artificiale del travaglio. Ginecologia-Ostetricia Encycl Méd Chir (Elsevier, Parigi), Amsterdam

    Google Scholar 

  5. Bishop EH (1964) Pelvic scoring for elective induction. Obstet Gynecol 24:266–268

    PubMed  CAS  Google Scholar 

  6. Watson WJ, Stevens D, Welter S, Day D (1996) Factors predicting successful labour induction. Obstet Gynecol 88:990–992

    Article  PubMed  CAS  Google Scholar 

  7. Reis FM, Gervasi MT, Florio P et al (2003) Prediction of successful induction of labor at term: role of clinical history, digital examination, ultrasound assessment of the cervix and fetal fibronectin assay. Am J Obstet Gynecol 189:1361–1367

    Article  PubMed  CAS  Google Scholar 

  8. Rozenberg P, Goffinet F, Hessabi M (2000) Comparison of the Bishop score, ultrasonographically measured cervical length and fetal fibronectin assay in predicting until delivery and type of delivery at term. Am J Obstet Gynecol 182:108–113

    Article  PubMed  CAS  Google Scholar 

  9. Rozenberg P, Chevret S, Ville Y (2005) Comparison of preinduction ultrasonographic cervical length and Bishop score in predicting risk of cesarean section after labor induction with prostaglandins. Gynécol Obstétr Fertil 33:17–22

    Article  CAS  Google Scholar 

  10. Roman H, Verspyck E, Vercoustre L et al (2004) The role of ultrasound and fetal fibronectin in predicting the length of induced labor when the cervix is unfavourable. Ultrasound Obstet Gynecol 23:567–573

    Article  PubMed  CAS  Google Scholar 

  11. Garite TJ, Casal D, Garcia Alonso A (1996) Fetal fibronectin: a new tool for the prediction of successful induction of labor. Am J Obstet Gynecol 175:1516–1521

    Article  PubMed  CAS  Google Scholar 

  12. Blanch G, Olah KSJ, Walkinshaw S (1996) The presence of fetal fibronectin in the cervicovaginal secretions of women at term: its role in the assessment of women before labor induction and in the investigation of the physiologic mechanisms of labor. Am J Obstet Gynecol 174:262–266

    Article  PubMed  CAS  Google Scholar 

  13. Ojutiku D, Jones G, Bewley S (2002) Quantitative fetal fibronectin as a predictor of successful induction of labour in post-date pregnancies. Eur J Obstet Gynecol Reprod Biol 101:143–146

    Article  PubMed  Google Scholar 

  14. Imai M, Tani A, Saito M et al (2001) Significance of fetal fibronectin and cytokine measurement in the cervicovaginal secretions of women at term in predicting term labor and post-term pregnancy. Eur J Obstet Gynecol Reprod Biol 97:53–58

    Article  PubMed  CAS  Google Scholar 

  15. Nuutila Mika, Hiilesmaa V, Karkkainen T, Ylikorkala O, Rutanen EM (1999) Phosphorylated isoforms of insulin-like growth factor binding protein-1 in the cervix as a predictor of cervical ripeness. Obstet Gynecol 94:243–249

    Article  PubMed  CAS  Google Scholar 

  16. Crane JM (2006) Factors predicting labor induction success: a critical analysis. Clin Obstet Gynecol 49:573–584

    Article  PubMed  Google Scholar 

  17. Lange AP, Secher NJ, Westgaard JG, Skovgard AI, Stat C (1982) Prelabour evaluation of inducibility. Obstet Gynecol 60:137–147

    PubMed  CAS  Google Scholar 

  18. Gonen R, Degani S, Ron A (1998) Prediction of successful induction of labor: comparison of transvaginal ultrasonography and the Bishop score. Eur J Ultrasound 7:183–187

    Article  PubMed  CAS  Google Scholar 

  19. Yang SH, Roh CR, Kim JH (2004) Transvaginal ultrasonography for cervical assessment before induction of labor. J Ultrasound Med 23:375–382

    PubMed  Google Scholar 

  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 24:538–539

    Article  PubMed  CAS  Google Scholar 

  21. Bartha JL, Romero-Carmona R, Martinez- Del Fresno P, Comino-Delgado R (2005) Bishop score and transvaginal ultrasound for preinduction cervical assessment: a randomized clinical trial. Ultrasound Obstet Gynecol 25:155–159

    Article  PubMed  CAS  Google Scholar 

  22. Bueno B, San-Frutos I, Perez-Medina T, Barbancho C, Trovano J, Bajo J (2007) The labor induction: integrated clinical and sonographic variables that predict the outcome. J Perinatol 27:4–7

    Article  PubMed  CAS  Google Scholar 

  23. Rizzo G, Capponi A, Rinaldo D, Tedeschi D, Arduini, Romanini C (1996) Interleukins-6 concentrations in cervical secretions identify microbial invasion of the amniotic cavity in patients with preterm labour and intact membranes. Am J Obstet Gynecol 175:812–817

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University “A. Avogadro”, Via Solaroli 17, 28100, Novara, Italy

    Francesca Riboni, Greta Garofalo & Delia Paternoster

  2. Department of Gynecology and Human Reproduction, University of Padova, Padua, Italy

    Irene Pascoli & Anna Vitulo

  3. Department of Obstetrics and Gynecology, Buzzi Hospital, Milan, Italy

    Marinella Dell’avanzo & Giuseppe Battagliarin

Authors
  1. Francesca Riboni
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  2. Greta Garofalo
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  3. Irene Pascoli
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  4. Anna Vitulo
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  5. Marinella Dell’avanzo
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  6. Giuseppe Battagliarin
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  7. Delia Paternoster
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Correspondence to Francesca Riboni.

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Riboni, F., Garofalo, G., Pascoli, I. et al. Labour induction at term: clinical, biophysical and molecular predictive factors. Arch Gynecol Obstet 286, 1123–1129 (2012). https://doi.org/10.1007/s00404-012-2432-1

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  • DOI: https://doi.org/10.1007/s00404-012-2432-1

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