Transvaginal Sonographic Measurement of Cervical Length Versus Bishop Score in Induction of Labour for Prediction of Caesarean Delivery.
Transvaginal Sonographic Measurement of Cervical Length Versus Bishop Score in Induction of Labour for Prediction of Caesarean Delivery.
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.
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.
Inclusion Criteria:

 -  1. Age (18-35) years. 2. Singleton pregnancy. 3. (37-42) weeks gestation. 4. Living
 fetus. 5. Cephalic presentation. 6. Absence of active labour. 7. No contraindication
 to vaginal delivery. 8. Average amount of clear liquor. 9. No history of uterine scar
 (myomectomy or previous C.S(.

 Exclusion Criteria:

 -  1. Malpresentation. 2. Major fetal congenital anomalies as hydrocephalous & dead
 fetus. 3. Patient received any pre induction ripping methods for example: (Acetic
 Acid-Prostaglandins).

 4. Any medical history contraindicating vaginal delivery. 5. Assessment meconium
 staining to liquor or any evidence of chorioamnionitis. 6. Previous uterine surgery.
 7. Multiple gestations. 8. Women with allergy to prostaglandins.