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

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.

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

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Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30214 Obstetrics and gynaecology

Country of publisher

Netherlands

Confidentiality degree

není předmětem státního či obchodního tajemství

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

Keywords in English

Dilapan; Mechanical; Cervical ripening; Induction; Labor

Tags

14110411, GPK, GPKpor, rivok

Tags

International impact, Reviewed

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Abstract

V originále

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.