The role of ultrasound and fetal fibronectin in predicting the length of induced labor when the cervix is unfavorable.

OBJECTIVE: To compare cervical clinical data, ultrasound parameters and fetal fibronectin assessment in the prediction of the duration of induced labor when the cervix is unfavorable. METHODS: This was a prospective study of 90 pregnant women with a Bishop score /= 27 mm (P = 0.002 and P = 0.005). CONCLUSION: Cervical dilatation as assessed by digital examination is the best predictor of the duration of the latent phase and of that of the whole of labor. Ultrasound measurement of cervical length is not more accurate at predicting the duration of labor than are clinical data.

Does ultrasound examination when the cervix is unfavorable improve the prediction of failed labor induction?

OBJECTIVE: To compare the Bishop score, ultrasound cervical parameters and fetal fibronectin assessment for predicting failed labor induction when the cervix is unfavorable. METHOD: 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%. CONCLUSION: 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.

[The value of magnesium pyrrolidone carboxylate in true cervix dystocia. A double blind versus placebo study]. / Intérêt du pyrrolidone carboxylate de magnésium dans les dystocies cervicales pures. Etude en double aveugle contre placebo.

The efficacy of spasmolytics in cervix dystocia during labor is very contested. For this reason the authors studied the action of pyrrolidone carboxylate of magnesium for this indication in a double-blind versus placebo study (48 patients divided in two groups). Strict inclusion criteria and homogeneity of the two groups of patients allowed them to find out that the use of this particular magnesium salt reduced significantly the length of labor. Consequently the authors assess that spasmolytics work not only through their placebo effect, which is thought by some authors.

[Maternal complications of cesarean section. Results of a multicenter study. I]. / Les complications maternelles des césariennes. Résultats d'une étude multicentrique (première partie).

The authors report a study they have made of 7,216 case histories designed to show the type and the number of the various maternal complications of the caesarean operation and compare these results with those found in the literature and those that occur after vaginal delivery. The maternal mortality rate directly associated with the operation is 1.38/000, which is between 5 and 25 times greater than those for vaginal delivery. The pre-operative anaesthetic and surgical complications are rare and are usually not very serious. They depend on the experience of the operators. The post-operative complications tend to be mainly due to infections and thrombo-embolic phenomena. If the most minor infections are included, the infection rate for caesarean operations rises to 20.6%, whereas thrombo-embolic complications are rare at 0.52%.

[Prevention of the risk of infection and thromboembolism following cesarean section. 2. Results of a multicenter study]. / Prévention du risque infectieux et thrombo-embolique après césarienne. Deuxième partie: Résultats d'une étude multicentrique.

The amount of infection following caesarean operations changes according to the indication for the caesarean and the length of time the membranes have been ruptured. Antibiotics should be prescribed according to these parameters. It does not seem that the numbers of thrombo-embolic complications in this series were reduced by using heparin prophylactically in the usual doses. It does seem to us that women with real factors for this risk should receive heparin in high doses to lower blood coagulation.