title: Does ultrasound examination when the cervix is unfavorable improve the prediction of failed labor induction?
abstract: OBJECTIVE
  To compare the Bishop score, ultrasound cervical parameters and fetal fibronectin assessment for predicting failed labor induction when the cervix is unfavorable.
  
  
  METHODS
  A prospective observational study was performed in 106 consecutive pregnant women with a Bishop score < or =5 undergoing labor induction. Assessment of fetal fibronectin and ultrasound measurement of cervical length, cervical wedging and cervical lip areas were performed. The relationship between these parameters and failure of labor induction was determined.
  
  
  RESULTS
  Failure of labor induction was defined as failure to reach a cervical dilatation of > or =5 cm, and it occurred in 16 patients (15.1%). Induction failure was associated with low Bishop scores before (P = 0.004) and 6 h after the start of induction (P = 0.007), increased clinical cervical length (P = 0.02) and increased ultrasound anterior cervical lip area (P = 0.04). The logistic regression model identified the Bishop score before induction (odds ratio = 2.25; 95% CI, 1.30-3.91; P = 0.003) and the clinical cervical length (odds ratio = 3.95; 95% CI, 1.3-11.7; P = 0.01) as being independent predictors of failed induction. To predict an induction failure, the best Bishop score cut-off value was 4, with a sensitivity of 87.5%, a specificity of 45.6%, a likelihood ratio of 1.58, a positive predictive value of 22.2% and a negative predictive value of 95.4%.
  
  
  CONCLUSIONS
  Compared with the Bishop score, cervical length by ultrasound is not a better predictor for the outcome of labor induction in an unfavorable cervix. Nevertheless, the Bishop score appears to be of poor predictive value for failed induction of labor.
authors.affiliation: Department of Gynaecology and Obstetrics, General Hospital, Le Havre, France. horace.roman@libertysurf.fr
authors.forename: H
authors.initials: H
authors.lastname: Roman
authors.forename: E
authors.initials: E
authors.lastname: Verspyck
authors.forename: L
authors.initials: L
authors.lastname: Vercoustre
authors.forename: S
authors.initials: S
authors.lastname: Degre
authors.forename: J Y
authors.initials: JY
authors.lastname: Col
authors.forename: J M
authors.initials: JM
authors.lastname: Firmin
authors.forename: P
authors.initials: P
authors.lastname: Caron
authors.forename: L
authors.initials: L
authors.lastname: Marpeau
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000737:chemistry / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005353:Fibronectins / Q000032:analysis; D006801:Humans; D007747:Labor Stage, First; D007751:Labor, Induced; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D016216:Ultrasonography, Prenatal / Q000379:methods*
chemical_list: D005353:Fibronectins