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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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