Can measurement of cervical length, fetal head position and posterior cervical angle be an alternative method to Bishop score in the prediction of successful labor induction?

AIM: The purpose of this study was to evaluate sonographic cervical length, posterior cervical angle and fetal head position in predicting successful induction of labor at term can be an alternative method to Bishop score. METHODS: This prospective observational study recruited 223 women with singleton gestations scheduled for induction of labor at 37-42 weeks. Parity, body mass index, Bishop score, fetal head position, cervical angle measurement and cervical length was investigated to predict successful labor induction. Multiple regression analysis was performed to determine the parameters in the prediction of successful vaginal delivery within 24 hours. RESULTS: Forty-five patients were excluded because of cesarean section performed for other reasons than arrest of dilation or fetal head descent (43 fetal distress, 2 cord prolapsus). Remaining 178 patients were divided into two groups according to duration of delivery time. 139 patients delivered within 24 hours were classified as group I, 39 patients delivered after 24 hours were classified as group II. Percentage of multiparity was statistically significantly higher in group I than in group II [59 (42.4%), 9 (23.0%) respectively, p = 0.009]. Cervical length was statistically significantly shorter in group I than in group II [23.1 ± 7.42 mm, 31.3 ± 6.83 mm respectively, p < 0.001]. Bishop score was statistically significantly higher in group I than in group II [3 (1-4), 1 (1-4) respectively, p < 0.001]. Posterior cervical angle was statistically significantly higher in group I than in group II [100.1 ± 17.2, 92.7 ± 21.4 respectively, p = 0.007]. According to the fetal head position, there was no statistically significant difference in labor duration between the groups (p = 0.787). In the multivariate regression analysis of variables, multiparity, cervical length and Bishop score were statistically significantly predictive in successful labor induction. CONCLUSION: Multiparity status, cervical length, posterior cervical angle and Bishop score can predict successful labor induction, but fetal head position is not predictive in successful labor induction.

Comparison of neutrophil/lymphocyte and platelet/ lymphocyte ratios for predicting malignant potential of suspicious ovarian masses in gynecology practice.

PURPOSE: To compare the diagnostic accuracy of the neutrophil/lymphocyte ratio (NLR) with the platelet/lymphocyte ratio (PLR) in predicting malignancy of pelvic masses which are pre-operatively malignant suspicious. MATERIALS AND METHODS: In this retrospective study we evaluated the clinical features of patients with ovarian masses which had pre-operatively been considered suspicious for malignancy. The patients whose intraoperative frozen sections were malign were classified as the study group, while those who had benign masses were the control group. Data recorded were age of the patient, diameter of the mass, pre-operative serum Ca 125 levels, platelet count, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio. RESULTS: There was statistically significantly difference between the groups in terms of age, diameter of the mass, serum Ca 125 levels, platelet number and platelet/lymphocyte ratio. Mean neutrophil/lymphocyte ratios showed no difference between the groups. ROC curve analysis showed that age, serum Ca 125 levels, platelet number and PLR were discriminative markers in predicting malignancy in adnexal masses. CONCLUSIONS: According to the current study, serum Ca 125 levels, pre-operative platelet number and PLR may be good prognostic factors, while NLR is an ineffective marker in predicting the malignant characteristics of a pelvic mass.

Meperidine versus valethamate bromide in shortening the duration of active labor.

OBJECTIVE: To compare the efficacy and safety of meperidine hydrochloride and valethamate bromide against placebo in shortening the duration of active labor. METHOD: We randomly assigned 160 nulliparous women with a singleton pregnancy at term who needed induction of labor to one of 3 treatments: 50 mg of meperidine (n=53), 16 mg of valethamate bromide (n=53), or a normal saline solution as placebo (n=54). All medications were given by slow intravenous infusion. Labor duration was the main outcome measure. RESULTS: The intervals between infusion and complete cervical dilation and between infusion and delivery were significantly reduced (P<0.001 and P<0.01) in the meperidine group (103.0+/-64.5 minutes and 119.8+/-70.2 minutes), in contrast to the placebo group (173.9+/-74.8 minutes and 192.2+/-82.8 minutes). However, differences were not significant between the 2 treatment groups (139.6+/-63.1 minutes and 160.6+/-71.9 minutes), or between the valethamate bromide and the placebo group. CONCLUSION: Meperidine, but not valethamate bromide, significantly shortened the duration of active labor in nulliparous women with a singleton pregnancy at term.