Ultrasound and clinical predictors for Caesarean delivery after labour induction at term

OBJECTIVE: To assess the relationship of ultrasound assessment for amniotic fluid, fetal weight, cervical length, cervical funneling and clinical factors on the risk of Caesarean delivery after labour induction at term. METHODS: On hundred and fifty-two women scheduled for labour induction at term agreed to participate. Sonography was performed to obtain fetal biometry, amniotic fluid index and cervical length and to detect funneling at the internal cervical os. The sonographic findings were concealed. Study women received standard care during labour induction. RESULTS: On univariate analysis using Fisher's exact test, parity, cervical length and Bishop score were associated with Caesarean delivery. Following multivariable logistic regression analysis, only nulliparity (adjusted odds ratio (AOR) 5.2 (95% CI 2.2-12.2): P<0.001) and transvaginal ultrasound-determined cervical length of more than 20 mm (AOR 2.8 (95% CI 1.0-7.4): P=0.04) were independent predictors of Caesarean delivery in labour induction. Maternal age, maternal height, gestational age, indication for labour induction, amniotic fluid index, cervical funneling and ultrasound-estimated fetal weight did not predict Caesarean delivery. CONCLUSION: In women who had undergone labour induction at term with a singleton fetus, nulliparity and cervical length of more than 20 mm on transvaginal sonography were independent predictors of Caesarean delivery. This information is helpful for pre-induction counselling.