Prospective evaluation of clinical and ultrasonic feto-maternal parameters as predictors of caesarean delivery after induction of labour

Abstract

Objectives: A prospective study was conducted in the department of obstetrics & Gynaecology, Kamla Nehru State Hospital for mother and child, Indira Gandhi Medical College, Shimla from 1st july 2010 to 30th april 2011 on 150 pregnant women. The aim was to evaluate the clinical and ultrasonic feto-maternal parameters which can predict the success of induction of labour. Methods: Gestational age, maternal height, weight, BMI, Bishop score, investigations including ultrasound, transabdominal scan to assess the fetal biometric parameters (BPD,HC,AC and FL), EFW, AFI & fetal head position and transvaginal scan to measure cervical length and cervical funnelling in all recruited subjects before initiating induction of labour (IOL) was done. After delivery, the women were allotted to one of the following groups: Group 1: women having caesarean delivery for non-progress of labour and failed induction of labour (non successful IOL group), Group 2: women having normal vaginal delivery (successful IOL group). Their clinical and ultrasonic parameters were compared. Results: Out of 150 pregnant women, 32 underwent caesarean delivery (21.33%).The t-test was used for quantitative data and Pearson Chi square or fisher’s exact test was used for categorical databases. The four variables which can significantly predict the failure of IOL in the present study were nulliparity, Bishop Score of < 3, Occipito-Posterior fetal head position on TAS and Birth weight ≥ 2.5 Kg. Conclusion: Clinical parameters nulliparity, Bishop score < 3, birth weight ≥ 2.5 kgs and ultrasonic parameter i.e. Occipito-Posterior fetal head positions are the 4 most significant parameters to predict the failure of IOL. Out of these parameters, the three best predictors were parity, birth weight and fetal head position. This can be useful in pre-induction counseling.