Midpregnancy Cervical Length in Nulliparous Women and its Association with Postterm Delivery and Intrapartum Cesarean Delivery.

OBJECTIVE: To evaluate the association between midpregnancy cervical length and postterm delivery and cesarean delivery during labor. STUDY DESIGN: In a multicenter cohort study, cervical length was measured in low-risk singleton pregnancies between 16 and 22 weeks of gestation. From this cohort, we identified nulliparous women who delivered beyond 34 weeks and calculated cervical length quartiles. We performed logistic regression to compare the risk of postterm delivery and intrapartum cesarean delivery to cervical length quartiles, using the lowest quartile as a reference. We adjusted for induction of labor, maternal age, ethnicity, cephalic position, preexisting hypertension, and gestational age at delivery. RESULTS: We studied 5,321 nulliparous women. Women with cervical length in the 3rd and 4th quartile were more likely to deliver at 42(+0) to 42(+6) weeks (adjusted odds ratio [aOR] 2.02, 95% confidence interval [CI] 1.07-3.79 and aOR 1.97, 95% CI 1.06-3.67, respectively). The frequency of intrapartum cesarean delivery increased with cervical length quartile from 9.4% in the 1st to 14.9% in the 4th quartile (p = 0.01). This increase was only present in intrapartum cesarean delivery because of failure to progress and not because of fetal distress. CONCLUSION: The longer the cervix at midtrimester the higher the risk of both postterm delivery and intrapartum cesarean delivery.

Transvaginal sonographic assessment of cervical length and wedging for predicting outcome of labor induction at term: a systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review and meta-analysis to assess the predictive capacity of transvaginal sonographic assessment of the cervix for the outcome of induction of labor. METHODS: We searched MEDLINE, EMBASE and the Cochrane Library, and manually searched reference lists of review articles and eligible primary articles. Studies in all languages were eligible if published in full. Two reviewers independently selected studies and extracted data on study characteristics, quality and test accuracy. We then calculated pooled sensitivities and specificities (with 95% CIs) and summary receiver-operating characteristics (sROC) curves. Outcome measures were test accuracy of sonographically measured cervical length and cervical wedging for Cesarean section, not achieving vaginal delivery within 24 h and not achieving active labor. RESULTS: We included 31 studies reporting on both cervical length and outcome of delivery. The quality of the included studies was mediocre. Sensitivity of cervical length in the prediction of Cesarean delivery ranged from 0.14 to 0.92 and specificity ranged from 0.35 to 1.00. The estimated sROC curve for cervical length indicated a limited predictive capacity in the prediction of Cesarean delivery. Summary estimates of sensitivity/specificity combinations of cervical length at different cut-offs for Cesarean delivery were 0.82/0.34, 0.64/0.74 and 0.13/0.95 for 20, 30 and 40 mm, respectively. For cervical wedging in the prediction of failed induction of labor summary point estimates of sensitivity/specificity were 0.37/0.80. CONCLUSIONS: Cervical length and cervical wedging as measured sonographically at or near term have moderate capacity to predict the outcome of delivery after induction of labor.

Ultrasonographic fetal head position to predict mode of delivery: a systematic review and bivariate meta-analysis.

OBJECTIVE: We performed a systematic review to determine whether sonographic assessment of occipital position of the fetal head can contribute to the prediction of the mode of delivery. METHODS: We performed a systematic literature search of electronic databases from inception to May 2011. Two reviewers independently extracted data from the included studies. We used a bivariate model to estimate point estimates for sensitivity and specificity curves for the outcome Cesarean delivery. Eligible studies were cohort studies or cross-sectional studies that reported on both the position of the fetal head, as assessed by ultrasound, before or at the beginning of active labor as well as the outcome of labor in women at term. RESULTS: We included 11 primary articles reporting on 5053 women, of whom 898 had a Cesarean section. All studies indicated disappointing values for sensitivity and specificity in the prediction of Cesarean section. Summary point estimates of sensitivity and specificity were 0.39 (95% CI, 0.32-0.48) and 0.71 (95% CI, 0.67-0.74), respectively. CONCLUSION: Sonographic assessment of occipital position of the fetal head before delivery should not be used in the prediction of mode of delivery.

Goal commitment to finding a partner and satisfaction with life among female singles: the mediating role of rumination.

In this cross-sectional study among 1502 female singles between the ages of 18 and 50, commitment to the goal of finding a partner was negatively related to satisfaction with life. In line with our expectations, this relationship was fully mediated by ruminating about being and remaining single. The relationship between rumination and lower satisfaction with life was stronger in the older age groups. The findings support the notion that rumination is an important mechanism through which goal commitment may negatively influence well-being, and that reducing one's level of commitment to the pursuit of stage-specific life goals may be beneficial when reaching a new developmental stage.

Validation of models that predict Cesarean section after induction of labor.

OBJECTIVE: Models for the prediction of Cesarean delivery after induction of labor can be used to improve clinical decision-making. The objective of this study was to validate two existing models, published by Peregrine et al. and Rane et al., for the prediction of Cesarean section after induction of labor. METHODS: We studied consecutive women in whom labor was induced. In all women, we recorded maternal age, height, body mass index, parity, gestational age and the Bishop score prior to induction. Cervical length was measured by transvaginal ultrasound immediately prior to induction of labor. The primary end-point was delivery by Cesarean section. The calibration of the two prediction models was assessed by comparison of predicted and observed Cesarean delivery rates. The discriminative capacity of the models, i.e. the ability of the models to distinguish subjects who had Cesarean section from those who did not (discrimination), was assessed by receiver-operating characteristics (ROC) analysis. RESULTS: We included 240 women in the study, of whom 27 (11%) had Cesarean delivery. The capacity of cervical length in the prediction of Cesarean delivery was limited. In our study population, both prediction models overestimated the risk of Cesarean delivery. Calibration was better for the Peregrine et al. model than for the Rane et al. model, and the two models had areas under the ROC curve of 0.76 and 0.67, respectively. CONCLUSION: Current models that predict the occurrence of Cesarean section after induction of labor have only a moderate predictive capacity when applied within a Dutch practice. We do not recommend the use of these prediction models in clinical practice.