According to the most recent data, one in 4 pregnant women in the U.S. undergoes induction of labor (IOL), a figure that has doubled over the past two decades. IOL is not only one of today’s most common obstetrical interventions, it is also one of the least predictable with respect to outcome (vaginal vs. cesarean delivery) and need for additional interventions. The increase in IOL has been paralleled by an increase in cesarean deliveries (CD). The relationship between IOL and CD is not straightforward, but it is clear that both have become significant public health issues because of their associated increased morbidity and resource utilization. For example, retrospective cohort studies demonstrate higher utilization in women who had elective IOL compared to those who were expectantly managed until spontaneous labor and CD is associated with definite higher morbidity (immediate and future) for the mother and data are accumulating to suggest this is also true for the neonate. Cervical readiness for labor is a well recognized key to success of IOL, which is rational given the cervix must completely soften and open to allow delivery of the baby. However, today’s clinicians have nothing better than subjective digital exam to assess the cervix for decisions about who should undergo induction or, if delivery is medically indicated, who should undergo cervical ripening (and what type) before IOL. They use a 50+-year old metric (Bishop score, BS) of cervical dilitation, length, softness, position and fetal head station that actually was intended for a different purpose. This is probably why the BS is a poor predictor of IOL success. That said, a likely reason the BS has been around for so long is that it makes intuitive sense that properties such as dilitation and softness would predict how the cervix will open because these are simply physical manifestations of biomechanical properties that dictate tissue strength and compliance. Therefore, it stands to reason that precise and accurate cervical evaluation should improve prediction of IOL success. Quantitative ultrasound techniques are promising for this purpose. A personalized, truly predictive measure of IOL success will require objective, quantitative information about each individual pregnant woman’s cervix with respect to its readiness for labor. To that end, this proposal describes a prospective, observational, cross-sectional study to evaluate whether quantitative ultrasound measures of cervical properties such as softness improve prediction of IOL success. Personalization of IOL could lead to improved ability to determine not only who should undergo induction, but perhaps also how that induction could best be accomplished. That, in turn, should decrease the public health impact of unsuccessful IOL.
|Effective start/end date
|9/7/18 → 8/31/21
- University of Wisconsin-Madison (856K531 // 1R01HD096361-01)
- National Institute of Child Health and Human Development (856K531 // 1R01HD096361-01)
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