title: The role of cervical Electrical Impedance Spectroscopy in the prediction of the course and outcome of induced labour.
abstract: BACKGROUND
  Previous work by us and others had suggested that cervical electrical impedance spectroscopy (EIS) may be predictive of the outcome of induced labour. We sought to determine which probe configuration of the EIS device is predictive of the outcome of induced labour and compare this to digital assessment by the Bishop score.
  
  
  METHODS
  In a prospective cohort of 205 women admitted for induction of labour, we used four probes of diameter 3, 6, 9 and 12 mm connected to an impedance meter to measure cervical resistivity (CR) in Ohm.meters at 14 electrical frequencies and compared their values to digital assessment of the cervix by the Bishop score for the prediction of the outcome of induced labour. We tested the association of labour characteristics and outcomes with CR and Bishop score by stepwise multilinear regression analyses, and the accuracy of prediction of categorical clinical outcomes by analysis of the area under the curves (AUC) of derived Receiver Operator Characteristic (ROC) curves.
  
  
  RESULTS
  Of the four CR probe dimensions studied, only the 12 mm probe was predictive of any labour indices. In the frequency range 19 - 156 kHz, CR obtained with this probe was higher in women who delivered by caesarean section (CS) than those who delivered vaginally, and in labours lasting > 24 hrs. Cervical resistivity at 78.1 kHz best predicted vaginal delivery [optimal cut-off <2.25 Ohm.meter, AUC 0.66 (95% CI 0.59-0.72), sensitivity 71.0%, specificity 56.5%, LR+ 1.63, LR- 0.51, P < 0.01] and labour duration >24 hrs [optimal cut-off 2.27 Omega.m, AUC 0.65 (95% CI 0.58, 0.72), sensitivity 71%, specificity 59%, LR+ 1.72, LR- 0.50, P < 0.05]. In contrast digital assessment by the Bishop score neither predicted vaginal delivery nor the duration of labour. However, Bishop score predicted time to onset of labour > 12 hours and induction-delivery interval < 24 hrs [optimal cut-off <or= 4, AUC 0.8 (95% CI 0.75, 0.86), sensitivity 77%, specificity 76%, LR+ 3.3, LR- 0.3, P < 0.05] whilst CR did not.
  
  
  CONCLUSIONS
  Cervical resistivity appears predictive of labour duration and delivery mode following induced labour. However the low predictive values obtained suggest that its current design proffers no immediate clinical utility.
authors.affiliation: University of Sheffield, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK. roobin1@hotmail.com
authors.forename: Roobin P
authors.initials: RP
authors.lastname: Jokhi
authors.forename: Brian H
authors.initials: BH
authors.lastname: Brown
authors.forename: Dilly O C
authors.initials: DO
authors.lastname: Anumba
mesh_terms: D000328:Adult; D019540:Area Under Curve; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000502:physiology*; D002585:Cesarean Section; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D007751:Labor, Induced / Q000009:adverse effects* / Q000379:methods; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000209:etiology*; D010808:Physical Examination; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012372:ROC Curve; D012815:Signal Processing, Computer-Assisted; D016896:Treatment Outcome; D018590:Uterine Monitoring / Q000379:methods*