목적: 유도분만시 Bishop 점수와 초음파를 이용하여 측정한 자궁경부 길이, 부피, 경부조직의 히스토그램 값으로 유도분만의 성공 예측이 가능한지 알아보고자 하였다. 연구 방법: 임신 34주에서 41주 사이의 유도분만이 예정된 Bishop 점수가 6점 이하인 41명의 미산부를 대상으로 하였다. 프로스타글란딘 E2 (PGE2, Propess®; Controlled Therapeutics Ltd) 페서리를 사용하였고, 자궁수축 유무에 따라 옥시토신을 추가 사용하여 유도분만을 시행하였다. ACCUVIX XQ (Medison) 초음파의 3차원 경질 탐촉자를 이용하여 자궁경부의 길이, 부피, 경부조직의 히스토그램값을 측정하였고 Bishop 점수는 내진을 통해 측정하였다. 유도분만의 성공은 PGE2 페서리 제거 후 12시간 이내에 4 cm 이상의 자궁경부 개대를 보이는 활성기에 도달한 경우로 정의하였다. 결과: 유도분만 성공률은 73.2% (30/41)였다. 다중 로지스틱 회귀분석에서 전방부 히스토그램 값이 유일하게 유도분만 성공 예측과 관계가 있었다. Receiver operating characteristic (ROC) curve 분석을 통해 유도분만 성공을 예측할 수 있는 전방부 히스토그램 값은 69.4였다. 결론: 질식 초음파를 이용한 전방부 히스토그램 측정값은 유도분만의 성공과 연관이 있다. 그러나 Bishop 점수와 자궁경부의 길이, 부피와 후방부 히스토그램 값은 성공여부를 예측할 수 없다.

Objective: The aim of this study was to evaluate whether the Bishop score, length, volume and gray-scale histogram of the cervix has a predictive value of assessing the rate of success in trial of induction. Methods: Forty-one nulliparous patients with its Bishop score six or less were enrolled for this prospective study. All were on prostaglandin E2 (PGE2, Propess®; Controlled Therapeutics Ltd) pessary. Three-dimensional transvaginal ultrasound scans of the cervix were performed on the ACCUVIX XQ (Medison) to measure length, volume, and gray-scale histogram. Bishop score was determined by digital examination. The successful induction was defined as the ability to achieve the active phase of labor corresponding to a cervical dilatation of ≥4 cm within 12 hours of removing the PGE2 pessary. The receiver operating characteristics (ROC) curves were also used to estimate an optimal cutoff point for the Bishop score, length, volume, and gray-scale histogram of the cervix. Logistic regression analysis was used for statistical analyses. Results: The overall successful rate of labor induction was 73.2% (30/41). Multiple logistic regression analyses demonstrated that the value of anterior lip histogram was significantly associated with the successful labor induction. ROC curve for anterior lip histogram value in predicting success of induction indicated a significant relationship with successful induction. The best cutoff value was 69.4. Conclusion: The value of anterior lip histogram associates significantly with the prediction of successful induction in nulliparous women. But, Bishop score and other sonographic measurement of cervical length, volume, and posterior lip histogram have no predictive values for successful induction.

Objective: The aim of this study was to evaluate whether the Bishop score, length, volume and gray-scale histogram of the cervix has a predictive value of assessing the rate of success in trial of induction. Methods: Forty-one nulliparous patients with its Bishop score six or less were enrolled for this prospective study. All were on prostaglandin E2 (PGE2, Propess®; Controlled Therapeutics Ltd) pessary. Three-dimensional transvaginal ultrasound scans of the cervix were performed on the ACCUVIX XQ (Medison) to measure length, volume, and gray-scale histogram. Bishop score was determined by digital examination. The successful induction was defined as the ability to achieve the active phase of labor corresponding to a cervical dilatation of ≥4 cm within 12 hours of removing the PGE2 pessary. The receiver operating characteristics (ROC) curves were also used to estimate an optimal cutoff point for the Bishop score, length, volume, and gray-scale histogram of the cervix. Logistic regression analysis was used for statistical analyses. Results: The overall successful rate of labor induction was 73.2% (30/41). Multiple logistic regression analyses demonstrated that the value of anterior lip histogram was significantly associated with the successful labor induction. ROC curve for anterior lip histogram value in predicting success of induction indicated a significant relationship with successful induction. The best cutoff value was 69.4. Conclusion: The value of anterior lip histogram associates significantly with the prediction of successful induction in nulliparous women. But, Bishop score and other sonographic measurement of cervical length, volume, and posterior lip histogram have no predictive values for successful induction.

Labor induction, Predictor, Histogram