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Background: The cervical favorability for IOL is assessed by scoring systems. There are various scoring systems, including the Field system, Lange pelvic scoring system, and Bishop scoring system, which was then modified and termed ‘The modified Bishop scoring system, and it is the most widely used one. This scoring is done based on the assessment of the station of the fetal presenting part, consistency, position, dilatation, and length of the maternal cervix. Owing to its subjective assessment, there is a high chance of inter-observer variability. Therefore, radiological methods such as Trans-vaginal ultrasonogram (TVS) and Trans-abdominal ultrasonogram (TAS) are preferred over manual methods. This study aims to determine the role of assessment of the cervix by Modified Bishop Score and assessment of the cervical parameters by Transvaginal ultrasonogram (TVS) and compare them in predicting the outcome of labour. Material and methods: This prospective observational study was conducted by the Department of Obstetrics and Gynecology in a tertiary care hospital located at Chengalpattu, Tamil Nadu, in a term singleton pregnancy woman, and the Study period was from January 2023 to July 2023 for six months. In total, one hundred fifty pregnant women were recruited. The study inclusion criteria were singleton pregnant women with intact amniotic membranes and a period of gestation >37 weeks with cephalic presentation. The findings of TVS were blinded to the person who measured cervical parameters for the bishop score. IOL done for both favorable and unfavorable cervix according to the guidelines given by FOGSI-ICOG (2018) for IOL. Results: Receiver operating characteristic (ROC) curve analysis showed the area under the curve (AUC) for the TVS score was 0.705(95 % CI: 0.616–0.794) against the standard bishop score. TVS Score≥6.5 cm is the best cut-off value to ascertain successful IOL with a sensitivity of 99 % and specificity of 94 % among singleton pregnancy women. Conclusion: This prospective observational study deduced that TVS scoring is a valid alternative tool against the standard bishop score in predicting cervical favorability for IOL among singleton pregnant women with plausible sensitivity and specificity. TVS scoring for assessing cervical favorability acts as an outstanding marker in predicting the IOL with a cut-off value of ≥6.5 cm in singleton pregnant women.

Background and purpose: The results of various studies on the effect of evening primrose oil (EPO) on cervical ripening are controversial. The purpose of this systematic review and meta-analysis was to assess the effect of EPO on cervical ripening and birth outcomes. Materials and methods: The Cochrane Library, Embase, PubMed, Scopus, Web of Science and Persian databases were searched for studies published from the inception of the databases up to February 2021 (search updated in May 2022). Full-text articles published in English or other languages, randomized controlled trials, and quasi experimental studies with control group were included. Studies published in form of conference proceedings, and those whose full texts were not available, as well as studies with control groups receiving other treatments for cervical ripening, and those in which the intervention group received drugs besides EPO were all excluded. The Cochrane handbook was used to determine the risk of bias of the included studies. All data were analyzed using Review Manager 5.4 and reported in forest plots. Results: Seven trials involving 920 women were included in the meta-analysis. In five studies, including 652 participants, cervical ripening was evaluated using Bishop score. The use of EPO was found to significantly improved Bishop score (MD = 3.23; 95% CI: 3.17, 3.29). The meta-analysis showed no significant differences between two comparison groups in terms of 1-min Apgar score and length of the second stage of labor. However, the two groups were significantly different in terms of their 5-min Apgar score and the time interval between administration of EPO and birth. Based on subgroup analysis by route of administration, both vaginal and oral use of EPO increased Bishop score significantly in the intervention group compared to the placebo group. Conclusion: This study showed that using EPO in term and post-term pregnant women was clinically effective in improving their Bishop score.

Introduction: Failed induction increased maternal morbidity and mortality due to the associated complication which comes with cesarean section such as post partum hemorrhage and sepsis. The reports of previous articles on the proportion and associated factor of failed induction were variable and inconsistent. Therefore, this meta-analysis found out that the pooled proportion of failed induction and its associated factors in Ethiopia. Methods: Systematic search was done by online databases (Pub Med, Web of Science, Google scholar and HINARI, and Ethiopian universities digital libraries). Unpublished studies that are found in the Ethiopian universities’ digital libraries were used for this systematic review and meta-analysis study. Data were entered into Microsoft Excel and then exported to STATA 11 version statistical software for analysis. Heterogeneity assessed using the I2 statistic. The pooled proportion of failed induction and the odds ratio (OR) with a 95% confidence interval was showed using forest plots. Result: The overall proportion of failed induction was 23.58 % (95% CI: 13.72–33.44). Unfavorable Bishop Score [OR = 4.45, 95CI:2.44,8.12 ] intermediate Bishop Score [OR = 8.87, 95CI:4.62,17.05 ] and being primiparous woman [OR = 3.04, 95CI:1.74,5.53 ] were factors associated with failed induction of labour. Conclusion: The prevalence of failed induction was high in Ethiopia. Unfavorable Bishop Score, intermediate Bishop Score, and primiparous were significantly associated with failed induction. Proper pelvis assessment for Bishop Score will be considered prior to initiating the induction of labor. Beside to this, the health professionals shall be aware of the relevance of cervical ripening for intermediate and unfavorable Bishop Score for pregnant women's before induction of labor.

Objective: We aimed to predict the perinatal outcomes and costs of health services following labour induction for late-term pregnancies. Materials and methods: We conducted a cohort study of 245 women who underwent labour induction during their 41st week of gestation. The cervical condition was assessed upon admission using the Bishop score and ultrasound cervical length measurements. We estimated the direct costs of labour induction, and a predictive model for perinatal outcomes was constructed using the decision tree analysis algorithm and a logit model. Results: A very unfavourable Bishop score at admission (Bishop score

Objective: To compare fetal fibronectin (fFN) assessment, ultrasound parameters, and Bishop score in the prediction of successful induction of labor at term when cervix is unfavorable. Materials and Methods: Seventy-three nulliparous women undergoing labor induction at term with Bishop score less than 5 were enrolled in this study. Successful labor induction was defined as vaginal delivery occurring within 24 hours of initiation of induction. fFN obtained from vaginal secretion was measured by immunoassay. Results: Patients who delivered within 24 hours (n = 33) differed significantly from the remaining patients by a positive fFN (84.8% vs. 15.2%, p = 0.002). The mean cervical length or Bishop scores were not statistically different between women who delivered vaginally before 24 hours of induction and those who did not (28.9 mm vs. 27.9 mm, p = 0.468 and 3.3 vs. 3.2, p = 0.928, respectively). Binary logistic regression analysis showed only the fFN immunoassay to be an independent statistically significant predictor of vaginal delivery within 24 hours of induction (odds ratio 6.168; 95% confidence interval 1.897–20.059; p = 0.002). A positive fibronectin assay had a sensitivity and specificity of 84.9% and 50%, respectively. Conclusions: In cases with unfavorable cervix, presence of vaginal fFN predicts the success of labor induction.

Objective: The aim of this study was to compare the efficacy and safety of a prostaglandin E2 (PGE2) vaginal insert with those of oxytocin for labor induction. The present study also examined whether its use reduces the rate of cesarean delivery in term pregnancies with premature rupture of membranes (PROM) and low Bishop scores. Materials and Methods: A total of 240 women with singleton pregnancies at ≥ 37 weeks, no prior uterine scar, vertex presentations, reactive nonstress tests, PROM for ≥ 12 hours and Bishop scores of ≤ 6 were randomly assigned to receive either oxytocin or vaginal PGE2. The primary outcomes were time from induction to delivery and mode of delivery. Results: The time from labor induction to active labor onset was significantly shorter in the oxytocin group than in the PGE2 group (4.9 ± 4.1 vs. 8.5 ± 3.6 hours; p = 0.02). The time from induction to delivery was also significantly shorter in the oxytocin group (3.4 ± 1.5 vs. 9.6 ± 4.7 hours; p = 0.02). Cesarean delivery rates were statistically similar in the oxytocin and PGE2 groups (18.3 vs. 20.0%; p = 0.81). Neonatal outcomes were comparable in both groups. Comparable results were observed for nulliparous women included in the study population. Conclusion: Oxytocin treatment seems to be superior to vaginal administration of PGE2 to induce labor in term pregnancies complicated with PROM and unfavorable services.

Background: Induction of labor occurs in >20% of pregnancies, which equates to approximately 1 million women undergoing an induction in the United States annually. Regardless of how common inductions are, our ability to predict induction success is limited. Although multiple risk factors for a failed induction have been identified, risk factors alone are not enough to quantify an actual risk of cesarean for an individual woman undergoing a cesarean., Objective: The objective of this study was to derive and validate a prediction model for cesarean after induction with an unfavorable cervix and to create a Web-based calculator to assist in patient counseling., Study Design: Derivation and validation of a prediction model for cesarean delivery after induction was performed as part of a planned secondary analysis of a large randomized trial. A predictive model for cesarean delivery was derived using multivariable logistic regression from a large randomized trial on induction methods (n = 491) that took place from 2013 through 2015 at an academic institution. Full-term (≥37 weeks) women carrying a singleton gestation with intact membranes and an unfavorable cervix (Bishop score ≤6 and dilation ≤2 cm) undergoing an induction were included in this trial. Both nulliparous and multiparous women were included. Women with a prior cesarean were excluded. Refinement of the prediction model was performed using an observational cohort of women from the same institution who underwent an induction (n = 364) during the trial period. An external validation was performed utilizing a publicly available database (Consortium for Safe Labor) that includes information for >200,000 deliveries from 19 hospitals across the United States from 2002 through 2008. After applying the same inclusion and exclusion criteria utilized in the derivation cohort, a total of 8466 women remained for analysis. The discriminative power of each model was assessed using a bootstrap, bias-corrected area under the curve., Results: The cesarean delivery rates in the derivation and external validation groups were: 27.7% (n = 136/491) and 26.4% (n = 2235/8466). In multivariable modeling, nulliparity, gestation age ≥40 weeks, body mass index at delivery, modified Bishop score, and height were significantly associated with cesarean. A nomogram and calculator were created and found to have an area under the curve in the external validation cohort of 0.73 (95% confidence interval, 0.72-0.74)., Conclusion: A nomogram and user-friendly Web-based calculator that incorporates 5 variables known at the start of induction has been developed and validated. It can be found at: http://www.uphs.upenn.edu/obgyn/labor-induction-calculator/. This calculator can be used to augment patient counseling for women undergoing an induction with an unfavorable cervix., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: We aimed to predict the perinatal outcomes and costs of health services following labour induction for late-term pregnancies., Materials and Methods: We conducted a cohort study of 245 women who underwent labour induction during their 41st week of gestation. The cervical condition was assessed upon admission using the Bishop score and ultrasound cervical length measurements. We estimated the direct costs of labour induction, and a predictive model for perinatal outcomes was constructed using the decision tree analysis algorithm and a logit model., Results: A very unfavourable Bishop score at admission (Bishop score <2) (OR, 3.43 [95% CI, 1.77-6.59]), and a history of previous caesarean section (OR, 7.72 [95% CI, 2.43-24.43]) or previous vaginal delivery (OR, 0.24 [95% CI, 0.09-0.58]) were the only variables with predictive capacity for caesarean section in our model. The mean cost of labour induction was €3465.56 (95% confidence interval [CI], 3339.53-3591.58). Unfavourable Bishop scores upon admission and no history of previous deliveries significantly increased the cost of labour induction. Both of these criteria significantly predicted the likelihood of a caesarean section in the decision tree analysis., Conclusion: The cost of labour induction mostly depends on the likelihood of successful trial of labour. Combined use of the Bishop score and previous vaginal or caesarean deliveries improves the ability to predict the likelihood of a caesarean section and the economic costs associated with labour induction for late-term pregnancies. This information is useful for patient counselling., (Copyright © 2017. Published by Elsevier B.V.)

Objective: Post-term pregnancy is frequently associated with higher fetal and maternal morbidity and mortality. Its management essentially depends on clinical cervical characteristics as evaluated by the Bishop score (BS). However, BS is poorly predictive of the delivery outcome. We sought to demonstrate that ultrasound measurement of cervical length and evaluation of fetal height could predict the outcome in post-term pregnancies., Methods: A prospective single center study was undertaken between the 21st of January and the 1st of June 2013. Fetal height was measured using a transperineal technique and cervical length was evaluated by a vaginal ultrasound on patients consulting and their term date. C-section rates were considered to be the primary judgment criteria., Results: A total of 136 patients were included. C-section rates in this population was 19%. Fetal height and cervical length were not different between the C-section group and the vaginal delivery group., Conclusion: Our study demonstrates that ultrasound measurement of cervical length and fetal height do not show better results than BS in predicting the outcome of post-term pregnancy. Combining these ultrasound measurements has already been suggested in other studies and promising results have been shown. More studies are necessary to further these results., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: To compare fetal fibronectin (fFN) assessment, ultrasound parameters, and Bishop score in the prediction of successful induction of labor at term when cervix is unfavorable., Materials and Methods: Seventy-three nulliparous women undergoing labor induction at term with Bishop score less than 5 were enrolled in this study. Successful labor induction was defined as vaginal delivery occurring within 24 hours of initiation of induction. fFN obtained from vaginal secretion was measured by immunoassay., Results: Patients who delivered within 24 hours (n = 33) differed significantly from the remaining patients by a positive fFN (84.8% vs. 15.2%, p = 0.002). The mean cervical length or Bishop scores were not statistically different between women who delivered vaginally before 24 hours of induction and those who did not (28.9 mm vs. 27.9 mm, p = 0.468 and 3.3 vs. 3.2, p = 0.928, respectively). Binary logistic regression analysis showed only the fFN immunoassay to be an independent statistically significant predictor of vaginal delivery within 24 hours of induction (odds ratio 6.168; 95% confidence interval 1.897-20.059; p = 0.002). A positive fibronectin assay had a sensitivity and specificity of 84.9% and 50%, respectively., Conclusions: In cases with unfavorable cervix, presence of vaginal fFN predicts the success of labor induction., (Copyright © 2016. Published by Elsevier B.V.)

Objective: Evaluate if a score based on ultrasound measurements (cervical length, perineal-fetal presentation distance, fetal occiput position) before the induction of labour is a good predictive test of vaginal delivery within 24h and compare it to Bishop score., Methods: From January to April 2014, we included in a monocentric prospective study 45 patients who underwent a labour induction in the department of obstetrics and gynecology at Croix-Rousse Hospital. Ultrasound measurements of the distance between the perineum and the foetal presentation (with transperineal ultrasound), of the cervical length (with transvaginal ultrasound) and of the position of the occiput were collected before induction. Bishop score was also calculated for these patients, without receiving ultrasound data (and vice versa), in order to determine the mode of induction. Receiver Operating Characteristics (ROC) curves were used to evaluate performance of the ultrasonographic score and the Bishop score for predicting vaginal delivery within 24h., Results: The area under the ROC curve for ultrasonographic score was 84.5% (IC95% 64,6-100%). The area under the ROC curve for Bishop score was 73.2% (IC95% 64,2-82,2%). The comparison of these areas under the curve has shown a difference of 11.3% with a P-value of 0.055 in a two-tailed test., Conclusion: Ultrasonographic score made with a combination of these ultrasound measurements appears to be an effective test to predict the chances of vaginal delivery within 24h of induction., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: To identify predictive factors for unsuccessful induction of labor within 24hours after dinoprostone insertion in post-term pregnancy with unfavorable cervix., Material and Methods: We retrospectively reviewed 325 singleton pregnancies with a diagnosis of post-term pregnancy and unfavorable cervix (Bishop score<6) during the period January 2012-Decembre 2012. Patients were classified into 2 groups: successful labor, defined as cervical ripening, within 24hours after dinoprostone insertion (Group R; n=248; 76.3 %) or failure group (Group E; n=77; 23.7 %). Antepartum and perpartum characteristics of women were compared., Results: Nulliparity (74.0 versus 56.0 %; OR=2.23; 95 % CI: 1.27-4.00; P=0.005), gestational age ≤41 SA+4 (53.2 versus 33.9 %; OR=2.22; 95 % CI: 1.32-3.74; P=0.003) and history of dilatation and curettage (27.3 versus 10.5 %; OR=3.19; 95 % CI: 1.66-6.11; P=0.0005) were significantly associated with unsuccessful induction of labor. Bishop score was significantly higher in Group R (3.6 versus 1.9; P=0.001). Also, consistency (74.0 versus 44.4 %; OR=3.57; 95 % CI: 2.04-6.40; P<10(-5)) and absence of dilatation of the cervix (59.7 versus 23.0 %; OR=4.97; 95 % CI: 2.89-8.56; P<10(-6)) were identified as significant predictive factors for unsuccessful induction of labor., Conclusion: Nulliparity, gestational age ≤41 SA+4, history of dilatation and curettage and Bishop score, in particular consistency and dilatation, are correlated with failure of cervical ripening in post-term pregnancy with unfavorable cervix., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)