Objective: To develop a model combining clinical and sonographic features to predict the risk of cesarean delivery after the induction of labor (IOL). Methods: We designed a prospective observational study involving women admitted for IOL. The main outcome was defined as cesarean delivery due to failed IOL or arrest of labor. Several clinical and ultrasonographic variables were collected. Seventy percent of the sample was used to build the predictive model, using stepwise logistic regression, while the remaining sample was used for validation. The final model was estimated and calibrated using all participants. Results: We analyzed 477 pregnancies. The main outcome occurred in 102/477 (21.4%) women. The final model included previous vaginal delivery (odds ratio [OR] 0.088; 95% confidence interval [CI] 0.04–0.21), height (OR 0.904; 95% CI 0.87–0.94), body mass index before delivery (OR 1.084; 95% CI 1.02–1.15), ultrasonographic estimated fetal weight (OR 3.965; 95% CI 2.18–7.22), and ultrasonographic cervical length (OR 1.065; 95% CI 1.04–1.09) as predictors. Area under the receiver operating characteristics curve was 0.826 (95% CI 0.78–0.87). For a 5% false-positive rate, the sensitivity, specificity, and positive and negative likelihood ratios were 44.1%, 94.9%, 8.7, and 0.59, respectively. Conclusion: Our model combining clinical and ultrasonographic features might offer individualized counseling regarding risk of cesarean delivery to women who are candidates for IOL.

1.
Ehrenthal
DB
,
Jiang
X
,
Strobino
DM
.
Labor induction and the risk of a cesarean delivery among nulliparous women at term
.
Obstet Gynecol
.
2010
Jul
;
116
(
1
):
35
42
.
[PubMed]
0029-7844
2.
Martin
JA
,
Hamilton
BE
,
Osterman
MJ
,
Driscoll
AK
,
Drake
P
.
Births: final Data for 2016
.
Natl Vital Stat Rep
.
2018
Jan
;
67
(
1
):
1
55
.
[PubMed]
1551-8922
3.
Wood
S
,
Cooper
S
,
Ross
S
.
Does induction of labour increase the risk of caesarean section? A systematic review and meta-analysis of trials in women with intact membranes
.
BJOG
.
2014
May
;
121
(
6
):
674
85
.
[PubMed]
1470-0328
4.
Ramirez
M
,
Ramin
S
;
ACOG Committee on Practice Bulletins — Obstetrics
.
ACOG Practice Bulletin No. 107: induction of labor
.
Obstet Gynecol
.
2009
Aug
;
114
(
2 Pt 1
):
386
97
.
[PubMed]
0029-7844
5.
Kolkman
DG
,
Verhoeven
CJ
,
Brinkhorst
SJ
,
van der Post
JA
,
Pajkrt
E
,
Opmeer
BC
, et al
The Bishop score as a predictor of labor induction success: a systematic review
.
Am J Perinatol
.
2013
Sep
;
30
(
8
):
625
30
.
[PubMed]
0735-1631
6.
Ivars
J
,
Garabedian
C
,
Devos
P
,
Therby
D
,
Carlier
S
,
Deruelle
P
, et al
Simplified Bishop score including parity predicts successful induction of labor
.
Eur J Obstet Gynecol Reprod Biol
.
2016
Aug
;
203
:
309
14
.
[PubMed]
0301-2115
7.
Elghorori
MR
,
Hassan
I
,
Dartey
W
,
Abdel-Aziz
E
.
A way to lend objectivity to Bishop score
.
J Obstet Gynaecol
.
2006
May
;
26
(
4
):
311
6
.
[PubMed]
0144-3615
8.
Hatfield
AS
,
Sanchez-Ramos
L
,
Kaunitz
AM
.
Sonographic cervical assessment to predict the success of labor induction: a systematic review with metaanalysis
.
Am J Obstet Gynecol
.
2007
Aug
;
197
(
2
):
186
92
.
[PubMed]
0002-9378
9.
Baños
N
,
Migliorelli
F
,
Posadas
E
,
Ferreri
J
,
Palacio
M
.
Definition of Failed Induction of Labor and Its Predictive Factors: Two Unsolved Issues of an Everyday Clinical Situation
.
Fetal Diagn Ther
.
2015
;
38
(
3
):
161
9
.
[PubMed]
1015-3837
10.
Verhoeven
CJ
,
Oudenaarden
A
,
Hermus
MA
,
Porath
MM
,
Oei
SG
,
Mol
BW
.
Validation of models that predict Cesarean section after induction of labor
.
Ultrasound Obstet Gynecol
.
2009
Sep
;
34
(
3
):
316
21
.
[PubMed]
0960-7692
11.
Levine
LD
,
Downes
KL
,
Parry
S
,
Elovitz
MA
,
Sammel
MD
,
Srinivas
SK
.
A validated calculator to estimate risk of cesarean after an induction of labor with an unfavorable cervix
.
Am J Obstet Gynecol
.
2018
Feb
;
218
(
2
):
254.e1
7
.
[PubMed]
0002-9378
12.
Hadlock
FP
,
Harrist
RB
,
Carpenter
RJ
,
Deter
RL
,
Park
SK
.
Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements
.
Radiology
.
1984
Feb
;
150
(
2
):
535
40
.
[PubMed]
0033-8419
13.
van Dillen
J
,
Diesch
M
,
Schutte
J
,
Zwart
J
,
Wolterbeek
R
,
van Roosmalen
J
.
Comparing grades of urgency for classification of cesarean delivery
.
Int J Gynaecol Obstet
.
2009
Oct
;
107
(
1
):
16
8
.
[PubMed]
0020-7292
14.
Kagan
KO
,
Sonek
J
.
How to measure cervical length
.
Ultrasound Obstet Gynecol
.
2015
Mar
;
45
(
3
):
358
62
.
[PubMed]
0960-7692
15.
Rane
SM
,
Guirgis
RR
,
Higgins
B
,
Nicolaides
KH
.
The value of ultrasound in the prediction of successful induction of labor
.
Ultrasound Obstet Gynecol
.
2004
Oct
;
24
(
5
):
538
49
.
[PubMed]
0960-7692
16.
Doyle
NM
,
Monga
M
.
Role of ultrasound in screening patients at risk for preterm delivery
.
Obstet Gynecol Clin North Am
.
2004
Mar
;
31
(
1
):
125
39
.
[PubMed]
0889-8545
17.
Peduzzi
P
,
Concato
J
,
Kemper
E
,
Holford
TR
,
Feinstein
AR
.
A simulation study of the number of events per variable in logistic regression analysis
.
J Clin Epidemiol
.
1996
Dec
;
49
(
12
):
1373
9
.
[PubMed]
0895-4356
18.
Peregrine
E
,
O’Brien
P
,
Omar
R
,
Jauniaux
E
.
Clinical and ultrasound parameters to predict the risk of cesarean delivery after induction of labor
.
Obstet Gynecol
.
2006
Feb
;
107
(
2 Pt 1
):
227
33
.
[PubMed]
0029-7844
19.
Gülmezoglu
AM
,
Crowther
CA
,
Middleton
P
,
Heatley
E
.
Induction of labour for improving birth outcomes for women at or beyond term
.
[Review]
.
Cochrane Database Syst Rev
.
2012
Jun
;
6
(
6
):
CD004945
.
[PubMed]
1469-493X
20.
Rane
SM
,
Guirgis
RR
,
Higgins
B
,
Nicolaides
KH
. Models for the prediction of successful induction of labor based on pre-induction sonographic measurement of cervical length. J Matern neonatal Med.
2005
;17(5):315–22.
21.
Rane
SM
,
Guirgis
RR
,
Higgins
B
,
Nicolaides
KH
.
Pre-induction sonographic measurement of cervical length in prolonged pregnancy: the effect of parity in the prediction of the need for Cesarean section
.
Ultrasound Obstet Gynecol
.
2003
;
22
(
1
):
40
4
.
[PubMed]
0960-7692
22.
Prado
CA C
,
Araujo Júnior
E
,
Duarte
G
,
Quintana
SM
,
Tonni
G
,
Cavalli
RC
, et al
Predicting success of labor induction in singleton term pregnancies by combining maternal and ultrasound variables
.
J Matern Fetal Neonatal Med
.
2016
Nov
;
29
(
21
):
3511
8
.
[PubMed]
1476-4954
23.
Crane
JM
.
Factors predicting labor induction success: a critical analysis
.
Clin Obstet Gynecol
.
2006
Sep
;
49
(
3
):
573
84
.
[PubMed]
0009-9201
24.
Goto
E
.
Comparing the accuracy of maternal, clinical, and ultrasound estimations to predict birthweight: a meta-analysis
.
Acta Obstet Gynecol Scand
.
2017
Nov
;
96
(
11
):
1289
99
.
[PubMed]
0001-6349
25.
Verhoeven
CJ
,
Opmeer
BC
,
Oei
SG
,
Latour
V
,
van der Post
JA
,
Mol
BW
.
Transvaginal sonographic assessment of cervical length and wedging for predicting outcome of labor induction at term: a systematic review and meta-analysis
.
Ultrasound Obstet Gynecol
.
2013
Nov
;
42
(
5
):
500
8
.
[PubMed]
0960-7692
26.
Parra-Saavedra
M
,
Gómez
L
,
Barrero
A
,
Parra
G
,
Vergara
F
,
Navarro
E
.
Prediction of preterm birth using the cervical consistency index
.
Ultrasound Obstet Gynecol
.
2011
Jul
;
38
(
1
):
44
51
.
[PubMed]
0960-7692
27.
Baños
N
,
Murillo-Bravo
C
,
Julià
C
,
Migliorelli
F
,
Perez-Moreno
A
,
Ríos
J
, et al
Mid-trimester sonographic cervical consistency index to predict spontaneous preterm birth in a low-risk population
.
Ultrasound Obstet Gynecol
.
2018
May
;
51
(
5
):
629
36
.
[PubMed]
0960-7692
28.
Baños
N
,
Perez-Moreno
A
,
Migliorelli
F
,
Triginer
L
,
Cobo
T
,
Bonet-Carne
E
, et al
Quantitative Analysis of the Cervical Texture by Ultrasound and Correlation with Gestational Age
.
Fetal Diagn Ther
.
2017
;
41
(
4
):
265
72
.
[PubMed]
1015-3837
29.
Baños
N
,
Perez-Moreno
A
,
Julià
C
,
Murillo-Bravo
C
,
Coronado
D
,
Gratacós
E
, et al
Quantitative analysis of cervical texture by ultrasound in mid-pregnancy and association with spontaneous preterm birth
.
Ultrasound Obstet Gynecol
.
2018
May
;
51
(
5
):
637
43
.
[PubMed]
0960-7692
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