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Clinical and Ultrasound Parameters to Predict the Risk of Cesarean Delivery After Induction of Labor

From the Departments of ¹Obstetrics and Gynaecology and ²Statistical Science, University College London Hospitals, London, United Kingdom.

OBJECTIVE: To evaluate whether factors in the maternal history and/or ultrasound parameters are useful in predicting the risk of cesarean delivery after induction of labor.

METHODS: Maternal age, height, body mass index, parity, gestational age, Bishop score, ultrasonic amniotic fluid volume, fetal head position, estimated fetal weight, and transvaginal cervical length were studied prospectively in 267 women at 36 or more weeks of gestation immediately before induction of labor. Logistic regression analysis was used to determine which factors best predicted the risk of cesarean delivery. Receiver operating characteristic curves and a resampling technique were used to evaluate the model’s performance.

RESULTS: Eighty (30%) of these 267 women had cesarean delivery. Logistic regression was performed and a final model chosen, which included parity (odds ratio [OR] 20.56, 95% confidence interval [CI] 7.97–53.05, P < .001), body mass index (OR 6.17, 95% CI 2.10–18.13, P < .001), height (OR 0.94, 95% CI 0.89–0.98, P = .005), and ultrasonic transvaginal cervical length (OR 1.07, 95% CI 1.04–1.11, P < .001) as the best predictors of cesarean delivery. A risk score was calculated containing these 4 parameters, which predicted reasonably accurately the risk of cesarean delivery.

CONCLUSION: Parity, body mass index, height, and ultrasonic transvaginal cervical length are the most accurate parameters in predicting the risk of cesarean delivery after induction of labor. A predictive model using these would allow more accurate counseling and better informed consent in the decision-making process regarding induction of labor

LEVEL OF EVIDENCE: II-2

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