الفهرس 
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Abstract
Traditionally, preinduction cervical assessment is based on the
digital examination of the cervix with evaluation of several variants. The
advantages of Bishop Score are that; it can evaluate parameters such as
consistency and station that may influence the outcome. A high Bishop
Score prior to IOL has been associated with successful IOL, shorter
duration of labor and a low rate of CS. Bishop Score does not require any
special equipment and has no cost; however its evaluation remains a
matter of controversy depending on the differences in the experience
and clinical senses of the examiners (Bishop, 1964).
Transvaginal sonographic measurement of the cervical length,
posterior cervical angle and Distance between fetal head and mother’s
perineum has been reported as a method which can predict successful
IOL; which if in a combination with other sonographic and non
sonographic parameters, its performance in prediction of induction
outcome will improve.
This is study in which the aim was to assess the efficacy and
tolerability of bishop Score assessment and transvaginal ultrasonographic
measurement of cervical length, posterior cervical angle and Distance
between fetal head and mother’s perineum in ladies undergoing labor
induction at term; to predict the mode of delivery.
This randomized trial was carried out at Department of Obstetrics
& Gynecology at Nasser Institute Hospital for research and treatment
from march 2013 to june 2015 after approval of Medical Ethics
Committee of the Hospital. it included 120 primigravida pregnant women
at term (≥37weeks) admitted to the hospital for induction of labor.
All cases in this study were subjected to Patient counseling, full
history taking, general and abdominal examinations were done, basic
investigations were done, Transvaginal measurement of cervical length,
posterior cervical angle with fetal head and distance between fetal head
and mother’s perineum then Peri-induction FHR monitoring For
evaluating fetal wellbeing. The lady was included when FHR trace was
reassuring Induction of labor by either misoprostol or Prostaglandin E2.
Cases included in the study were divided into 2 groups (A&B)
1- group A
- Induction was carried out by misoprostol, vaginal misoprostol
was administered according to the following protocol:
25μg was placed in the posterior fornix every 4hours until effective
labor contractions obtained for a maximum of 4doses.
Misoprostol used was the 25μg misoprostol was prepared with a
cutter. The decision for application of the second, third misoprostol tablet
was made by assessing the cervical status and fetal heart rate.
2- group B
- Induction was carried out by Prostaglandine E2, vaginal
Prostaglandine E2 was administered according to the following protocol:
3mg was placed in the posterior fornix every 6 hours until effective
labor contractions obtained for a maximum of 2doses.
If labor doesn’t start after each regimen, cesarean section will be
done.
All women enrolled will be monitored by CTG (cardiotocography).
Successful induction of labor will be considered when each patient
has vaginal delivery within 24 hours.
Augmentation of labour with oxytocin will be started in women
who have cervical dilatation of 4 cm or more with unsatisfactory progress
of labor (arrest of cervical dilatation of ≥ 2 hours and /or inadequate
uterine activity) after four hours of the last prostaglandin dose in
induction regimen.
Induction of labor regimen will be discontinued if the participant
develops severe diarrhea, vomiting, signs of fetal or maternal distress, or
uterine hypercontractility, tachycardia, fever or rigors.
The overall vaginal delivery rate was 70%. Vaginal delivery rate
was significantly higher in group (A) than group (B) but with no
statistically significant difference. However Induction delivery interval in
group (A) was longer than Induction delivery interval of groub (B)
(12.1±2.2h vs11.2±2.5h) with statistically significant difference (P =
0.037).
In the present study, it was found that there were no statistically
significant differences, as regarding the mean age of the study population,
the mean gestational age, BMI and the mean preindution Bishop score,
cervical length, posterior cervical angle, distance fetal head mother’s
perineum in both groups.
The present study resulted in cut-off values for Bishop Score>4
and for sonographic cervical length <2.75 cm, Post cervical angle >120°
and distance fetal head mother’s perineum <4.25cm to predict successful
IOL. ROC showed that, accuracy of Bishop Score (area under the curve,
AUC) (94.3%), for cervical length (96.05%), Post cervical angle (94.4%)
and distance fetal head mother’s perineum (91%)) in predicting successful
IOL.
In this study, failed induction in both group was accounted for
most of the indications for cesarean section. group (B) had higher rate
than group (A), with no statistically significant. no significant postpartum
complication (postpartum hemorrhage, admission to intensive care unit
(I.C.U). there was no perinatal deaths but 3.3% of the newborn had been
admitted to the neonatal intensive care unit ( N.I.C.U)