The use of sonographic myometrial thickness measurements for the prediction of time from induction of labor to delivery.

BACKGROUND: Several attempts have been made to find tools for the prediction of successful induction of labor. Sonographic myometrial thickness has not yet been investigated regarding its use as a clinical tool for the course of labor induction. OBJECTIVE: To evaluate the role of sonographic measurement of myometrial thickness in the prediction of the time interval to successful vaginal delivery after induction of labor. STUDY DESIGN: A prospective study was conducted including term singleton pregnancies with a vertex presentation designated for balloon induction at 38-42 weeks gestation. Prior to induction, abdominal sonographic myometrial thickness was assessed at five locations: lower uterine segment (above and below the reflection of the urinary bladder), mid-anterior wall, fundus and posterior uterine wall. Induction of labor was then carried out with a trans-cervical Foley catheter that was substituted with intravenous oxytocin after balloon expulsion. The parameters assessed were successful induction of labor resulting in a vaginal delivery and the time interval from balloon insertion to balloon expulsion, the time interval from initiation of oxytocin administration to delivery and the total time from balloon insertion to delivery. RESULTS: Fifty-two women were recruited to the study. Indications for labor induction were: post-date pregnancy (48.1%), gestational diabetes mellitus (19.2%), oligohydramnios (11.5%), gestational hypertensive disorders (5.8%) and other indications (15.4%). Vaginal delivery was achieved in 46 patients (88.5%). A statistically significant correlation was found between fundal and posterior uterine wall myometrial thickness and time from induction to balloon expulsion (r = 0.36, p = 0.03; r = - 0.35, p = 0.05, respectively). This correlation remained significant in a multivariate logistic regression model controlling for confounders. A correlation between myometrial thickness and the total time from induction to delivery was not statistically significant. CONCLUSION: Myometrial fundal and posterior uterine wall thickness in women undergoing labor induction with a balloon catheter was found to be correlated with the interval from balloon insertion to expulsion. Our findings support further investigations into the use of sonographic myometrial thickness as part of the assessment prior to induction of labor.

Fetal wide subarachnoid space and its outcome in cases of macrocephaly without ventriculomegaly.

Objective: To examine the occurrence and outcomes of fetuses with wide subarachnoid space (WSS) without ventriculomegaly in pregnant women with fetal macrocephaly as a sole diagnosis.Study design: A retrospective study was performed, analyzing patients with fetal macrocephaly between the years 2008 and 2018. All these patients underwent MRI, in order to detect brain anomalies. In the absence of any other brain abnormality, they were evaluated for WSS and their offspring's database was followed for at least two years after birth.Results: Ten patients were found to be carrying fetuses with macrocephaly, nine of them were diagnosed with WSS without ventriculomegaly prior to delivery. Following at least two years of follow up, all patients did not present significant neurodevelopmental abnormalities, apart from one child that had a genetic mutation of 15q21.2-22.31 deletion with other anomalies that were not diagnosed prenatally.Conclusions: We present herein for the first time in the literature a cohort of patients with a prenatal diagnosis of WSS without ventriculomegaly in fetuses with macrocephaly. Our data show that, in the presence of normal anomaly scan and normal chromosomal study, there is a low chance for significant neurodevelopmental abnormalities in fetuses with WSS without ventriculomegaly.

The use of sonographic cervical length assessment for the prediction of time from induction to delivery.

OBJECTIVE: The objective of this study is to investigate the role of trans-vaginal cervical length measurement in the prediction of the interval to successful vaginal delivery after induction of labor with balloon catheter. METHODS: In this prospective study of cervical length measurement before induction of labor, singleton pregnancies that underwent induction of labor between 37 and 42 weeks of gestation were included. The data collected included trans-vaginal sonographic cervical measurements followed by digital cervical assessment. Bishop score was used to quantify digital assessment (before induction of labor). RESULTS: During the study period, 71 patients were included in the study. A statistically significant linear correlation was found between sonographic cervical length prior to induction of labor and the time of delivery (Pearson correlation 0.335; p values 0.005). Of the 57 vaginal deliveries, 27 patients had a cervical length of less than 28 mm. Patients with a cervical length of less than 28 mm had a significantly shorter time to delivery compared to patients with more than 28 mm length (20.4 versus 28.7, respectively; p value = 0.019). Cervical length of 28 mm remained significantly correlated even after performing several logistic regression models in order to control for confounders such as parity and age. In addition, a correlation was found between Bishop scores of above 7 to the time to delivery. CONCLUSIONS: Cervical length is correlated linearly to the time interval between induction of labor and delivery. A cervical length of less than 28 mm was found to be statistically significant in predicting a shorter time to delivery.