Transvaginal Sonographic Measurement of Cervical Length Versus Bishop Score in Induction of Labour for Prediction of Caesarean Delivery.
Condition: Failed Induction; Cervical Dystocia
MeSH terms: Dystocia
Study type: Observational

Summary: 
      Transvaginal sonographic measurement of cervical length versus Bishop score in labour
      induction at term for prediction of Caesarean delivery. This study is prospective study. This
      study will be carried out in Ain-shams maternity hospital. Sample size of 320 parturients.
    

Detailed description: 
      Patients and Methods

      Study design:

      This study is prospective study, comparative clinical trial for a test against a gold
      standard with blinding of the evaluator

      Study setting:

      This study will be carried out in Ain-Shams university maternity hospital.

      Methods:

        -  All patients recruited were given an oral consent.

        -  All patients were subjected to the following:

      History of the patient:

        -  Detailed and careful history was taken from the patient as the following:

             1. Personal history: name, age, occupation, residence and special habit of medical
                importance.

             2. Obstetric history: including last menstrual period, Gestation age and regular
                Antenatal care.

             3. Past history: including any medical disorder e.g. Diabetes mellitus, hypertension
                or any surgical procedure

             4. History of present pregnancy: duration of pregnancy from last menstrual period, any
                complications occurred or any medication used during pregnancy.

                Examination of the patient:

             1. General examination: as regard level of consciousness, vital data, and complexion.

             2. Abdominal examination: as regard fundal level, lie of the fetus, detection of any
                uterine contractions and fetal heart rate.

             3. Pelvic Examination: as regard pelvic capacity, presenting part, presence of rupture
                of membranes and cervical assessment as regard cervical dilation, station and
                presenting part.

        -  Investigations. Complete blood count , Rh, transvaginal ultra sound and non-stress test.

        -  All patients had vaginal examination for assessing the (Bishop Score,1964) before
           induction of labour.

        -  All women had transvaginal ultrasound for assessment of cervical length using (median
           digital GAIA) Ultrasonic machine.

      Protocol of transvaginal ultrasound will be done as follow:

        1. Patient will be asked to void.

        2. Vaginal probe will be inserted using direct visualization with K-Y gel.

        3. Identification of bladder, amniotic fluid and fetal presenting part.

        4. Identification of abnormal findings as placenta pervia or absence of fetal heart motion.

        5. Identification of midline sagittal plane of the cervix and looking in the proximal one
           third of the image for the internal os then pulling back the probe until the lightest
           touch provides good image of the cervical canal and moving the probe slightly to get the
           best long axis of the cervix then measuring the cervical length by placing the calipers
           appropriately and recording the distance between internal and external cervical os.

             -  Transvaginal ultrasound will be done to assess cervical length using medison
                sonoace 8800 (median digital GAIA) ultrasound machine equipped with a 7.5 m hertz
                by vaginal probe in Ain-Shams University Maternity Hospital.

             -  Induction of labour will be done using intravaginal misoprostol (25 microgram) then
                digital examination will be made 6 h after the first intravaginal administration;
                if necessary, 3 doses were given at 6 hours interval. External Cardiotocography
                will be regularly performed to monitor the condition of the fetus.

             -  Continuous Cardiotocography will be used in all cases. If necessary, amniotomy will
                be performed. Intravenous oxytocin administration will be started when there is an
                arrest of dilatation, starting at 1milli-international unit/minute and increasing 1
                mIU every 30 min as necessary. For analgesia, intramuscular pethidine will be
                offered.

             -  Caesarean delivery will be done due to pathological fetal heart rate trace, arrest
                the fetal head for at least one hour despite adequate uterine contractions.
    

Intervention name(s): Bishop score calculation of modified Bishop score in numbers by digital vaginal examination
Intervention type(s): Other
Intervention description(s): Measurement of cervical length by transvaginal ultrasound and digital examination of Bishop score in 320 parturients undergoing labour induction at term
Other intervention name(s): cervical length measuring cervical length by trans-vaginal ultrasound
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Single group 320 parturients udergoing induction of labour at term