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@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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