Predictors of vaginal delivery after cervical ripening using a
synthetic osmotic dilator

J 2020

Predictors of vaginal delivery after cervical ripening using a synthetic osmotic dilator

SAAD, Antonio F.; Janesh GUPTA; Lukáš HRUBAN; Gary D. HANKINS; George R. SAADE et. al.

Basic information

Original name

Predictors of vaginal delivery after cervical ripening using a synthetic osmotic dilator

Authors

SAAD, Antonio F. (840 United States of America); Janesh GUPTA (826 United Kingdom of Great Britain and Northern Ireland); Lukáš HRUBAN (203 Czech Republic, belonging to the institution); Gary D. HANKINS (840 United States of America) and George R. SAADE (840 United States of America)

Edition

EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY, AMSTERDAM, ELSEVIER SCIENCE BV, 2020, 0301-2115

Other information

Language

English

Type of outcome

Article in a journal

Field of Study

30214 Obstetrics and gynaecology

Country of publisher

Netherlands

Confidentiality degree

is not subject to a state or trade secret

References:

URL

Impact factor

Impact factor: 2.435

RIV identification code

RIV/00216224:14110/20:00115800

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.ejogrb.2020.01.048

UT WoS

000518494100029

EID Scopus

2-s2.0-85078792051

Keywords in English

Dilapan; Mechanical; Cervical ripening; Induction; Labor

Abstract

In the original language

Objective: To evaluate the determinants of vaginal delivery and safety in women undergoing cervical ripening with a synthetic osmotic dilator (Dilapan-S) prior to induction of labor. Methods: We conducted a secondary analysis of an international multicenter prospective observational study of Dilapan-S for cervical ripening in pregnancies greater than 32 weeks. Data were obtained in a standardized fashion and entered into a centralized electronic data capture system. The association between Bishop score and vaginal delivery was further evaluated with a multivariate receiver-operating characteristic (ROC) curve analysis. A Wilcoxon rank test and multivariable logistic regression were used for statistical analysis (significance: P < .05). Results: Between May 2015 and July 2016, 444 pregnant women were included. Three hundred ten (70 %) delivered vaginally. Compared to patients who underwent cesarean delivery, those who delivered vaginally were more likely to have a history of prior vaginal delivery. Vaginal delivery rates were significantly correlated with Bishop scores of pre and post Dilapan-S and difference. After adjusting for age, BMI, number of dilators, cervical ripening time, and gestational age, both prior vaginal delivery and post-Dilapan-S Bishop scores were strong predictors of vaginal delivery (estimate coefficient: 0.1275 +/- 0.03 P = .0002; 0.049 +/- 0.01 P = .0001; respectively). Aggregate ROC accounting for these variables further supported these findings (AUC = 0.734). The lower confidence interval limit of vaginal delivery rates was above 50 % when post-Dilapan-S Bishop scores were >= 5. Cox regression analyses demonstrated that the duration of labor was significant shorter in women that had vaginal delivery. Conclusion: Bishop scores after cervical ripening with Dilapan-S are good predictors of vaginal delivery. Bishop scores < 5 post Dilapan-S may warrant further cervical ripening. Further level 1 trials are needed to compare osmotic dilators to other ripening methods. (C) 2020 Elsevier B.V. All rights reserved.

Cite

SAAD, Antonio F.; Janesh GUPTA; Lukáš HRUBAN; Gary D. HANKINS and George R. SAADE. Predictors of vaginal delivery after cervical ripening using a synthetic osmotic dilator. EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY. AMSTERDAM: ELSEVIER SCIENCE BV, 2020, vol. 246, March 2020, p. 160-164. ISSN 0301-2115. Available from: https://dx.doi.org/10.1016/j.ejogrb.2020.01.048.

@article{1662598,
   author = {Saad, Antonio F. and Gupta, Janesh and Hruban, Lukáš and Hankins, Gary D. and Saade, George R.},
   article_location = {AMSTERDAM},
   article_number = {March 2020},
   doi = {http://dx.doi.org/10.1016/j.ejogrb.2020.01.048},
   keywords = {Dilapan; Mechanical; Cervical ripening; Induction; Labor},
   language = {eng},
   issn = {0301-2115},
   journal = {EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY},
   title = {Predictors of vaginal delivery after cervical ripening using a synthetic osmotic dilator},
   url = {https://www.sciencedirect.com/science/article/pii/S0301211520300579?via%3Dihub},
   volume = {246},
   year = {2020}
}

TY  - JOUR
ID  - 1662598
AU  - Saad, Antonio F. - Gupta, Janesh - Hruban, Lukáš - Hankins, Gary D. - Saade, George R.
PY  - 2020
TI  - Predictors of vaginal delivery after cervical ripening using a synthetic osmotic dilator
JF  - EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY
VL  - 246
IS  - March 2020
SP  - 160-164
EP  - 160-164
PB  - ELSEVIER SCIENCE BV
SN  - 03012115
KW  - Dilapan
KW  - Mechanical
KW  - Cervical ripening
KW  - Induction
KW  - Labor
UR  - https://www.sciencedirect.com/science/article/pii/S0301211520300579?via%3Dihub
L2  - https://www.sciencedirect.com/science/article/pii/S0301211520300579?via%3Dihub
N2  - Objective: To evaluate the determinants of vaginal delivery and safety in women undergoing cervical ripening with a synthetic osmotic dilator (Dilapan-S) prior to induction of labor. Methods: We conducted a secondary analysis of an international multicenter prospective observational study of Dilapan-S for cervical ripening in pregnancies greater than 32 weeks. Data were obtained in a standardized fashion and entered into a centralized electronic data capture system. The association between Bishop score and vaginal delivery was further evaluated with a multivariate receiver-operating characteristic (ROC) curve analysis. A Wilcoxon rank test and multivariable logistic regression were used for statistical analysis (significance: P < .05). Results: Between May 2015 and July 2016, 444 pregnant women were included. Three hundred ten (70 %) delivered vaginally. Compared to patients who underwent cesarean delivery, those who delivered vaginally were more likely to have a history of prior vaginal delivery. Vaginal delivery rates were significantly correlated with Bishop scores of pre and post Dilapan-S and difference. After adjusting for age, BMI, number of dilators, cervical ripening time, and gestational age, both prior vaginal delivery and post-Dilapan-S Bishop scores were strong predictors of vaginal delivery (estimate coefficient: 0.1275 +/- 0.03 P = .0002; 0.049 +/- 0.01 P = .0001; respectively). Aggregate ROC accounting for these variables further supported these findings (AUC = 0.734). The lower confidence interval limit of vaginal delivery rates was above 50 % when post-Dilapan-S Bishop scores were >= 5. Cox regression analyses demonstrated that the duration of labor was significant shorter in women that had vaginal delivery. Conclusion: Bishop scores after cervical ripening with Dilapan-S are good predictors of vaginal delivery. Bishop scores < 5 post Dilapan-S may warrant further cervical ripening. Further level 1 trials are needed to compare osmotic dilators to other ripening methods. (C) 2020 Elsevier B.V. All rights reserved.
ER  -

SAAD, Antonio F.; Janesh GUPTA; Lukáš HRUBAN; Gary D. HANKINS and George R. SAADE. Predictors of vaginal delivery after cervical ripening using a synthetic osmotic dilator. \textit{EUROPEAN JOURNAL OF OBSTETRICS \&{}amp; GYNECOLOGY AND REPRODUCTIVE BIOLOGY}. AMSTERDAM: ELSEVIER SCIENCE BV, 2020, vol.~246, March 2020, p.~160-164. ISSN~0301-2115. Available from: https://dx.doi.org/10.1016/j.ejogrb.2020.01.048.

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