A comparative study of posterior cervical angle and BISHOP’S score for labour induction and outcome.pptx

Pg thesis dissertation on posterior cervical angle

1. A comparative study of posterior cervical angle and BISHOP’S score for labour induction and outcome Principal Investigator : Dr.Sanddya Murugesan OBG Postgraduate SRM Medical College & Research Centre Guide : Dr.Vidhyalakshmi Co- Guide Department of Obstetrics & Gynaecology SRM Medical College & Research Centre : Dr. Senior resident Department of Obstetrics & Gynaecology SRM Medical College & Research Centre

2. Introduction ► Induction of labour is an artificial method of initiating uterine contractions before the onset of spontaneous labour, leading to progressive dilatation and effacement followed by delivery Modified bishop score is the most commonly used method for the evaluation of pre- induction favourability of cervix However it has a high inter and intra observer variability and it’s sensitivity is 23- 64% TVS has been demonstrated to be more sensitive than the modified bishop’s score in induction of labour in recent years, as it avoids inter observer variations

3. The TVUS measurement of the posterior cervical angle could represent a more accurate assessment of the cervix than the digital cervical examination Also it is difficult to asses effacement in a closed cervix , as effacement starts at the level of internal os Digital examination of the cervix is associated with fear of examination, pain , anxiety and discomfort

4. Study Justification Posterior cervical angle is simple and easy to measure. The TVUS measurement of the posterior cervical angle could represent a more accurate assessment than the modified bishop’s score in the prediction of successful induction.

5. Hypothesis Posterior Cervical angle is a single better predictor of labour induction and outcome than modified bishop’s score

6. AIMS & OBJECTIVES • Aims: To compare the efficacy of posterior cervical angle and BISHOP’S score for labour induction and outcome Objectives: To study the efficacy of posterior cervical angle in predicting the successful vaginal delivery To study the labour induction outcome in different ranges of posterior cervical angle measurement

7. REVIEW OF LITERATURE AUTHOR NAME JOURNAL TOPIC REMARKS Eun- ju kim, Jim man heo , no- eon Kim Diagnostics 2021 oct 15 The value of posterior cervical angle as a predictor of vaginal delivery Posterior cervical angle of >96.5 degree is associated with successful induction of labour Sangeetha Gupta, neetika Pandey, taru Gupta Journal of clinical and diagnostic research 2022 58314_CE Role of translational sonographic parameters in predicting outcomes of induction of labour: A prospective observational study TVS parameters when combined were found to be more specific and sensitive as compared to the modified Bishop score in predicting successful labour induction

8. STUDY DESIGN Type of study : Comparative study ► Study design : Prospective study Period : March 2024 - March 2026 Setting : SRM Medical College Hospital and Research Centre Study population : Antenatal patients with term singleton pregnancy with intact membranes for induction of labour in labour ward at SRM Medical College.

9. INCLUSION CRITERIA Inclusion Criteria : • The study to be conducted in women admitted in SRM medical college, Chengalpattu with term gestation planned for induction of labour

10. Exclusion Criteria • • Previous cesarean section Preterm pregnancy multifetal gestation Exclusion Criteria:

11. Sample size calculation

12. STATISTICAL ANALYSIS • • • The collected data will be transformed into variables, coded and entered in Microsoft excel. Data will be analysed and statistically evaluated using statistical package for social sciences (SPSS) software

13. METHODOLOGY The study will be conducted at SRM Medical College Hospital Subjects will be selected from the patients with term gestation who are planned for induction after checking inclusion and exclusion criteria at SRM medical college and hospital labour ward . At the time of enrollment, written consent will be obtained. For eligible and consenting participants, using transvaginal ultrasound, posterior cervical angle will be measured and modified bishops score will be calculated.

14. Outcome: Efficacy of posterior cervical angle in predicting the successful vaginal delivery Labour induction outcomes in different ranges of Posterior cervical angle Comparison of posterior cervical angle and bishop’s score in predicting the labour induction and outcome

15. REFERENCES: Kim EJ, Heo JM, Kim HY, Ahn KH, Cho GJ, Hong SC, Oh MJ, Lee NW, Kim HJ. The Value of Posterior Cervical Angle as a Predictor of Vaginal Delivery: A Preliminary Study. Diagnostics (Basel). 2021 Oct 25;11(11):1977. doi: 10.3390/diagnostics11111977. Erratum in: Diagnostics (Basel). 2022 Jul 06;12(7): PMID: 34829323; PMCID: PMC8618642. Sabry S M H, Ahmed E A O, Ahmed M E El- Din M M. Cervical Length and Posterior-Cervical Angle in Prediction of Successful Induction of Labor. J Gynecol Women’s Health 2022: 23(3): 556112. DOI:10.19080/JGWH.2022.23.556112 Dewandeleer S, Hansske A, Parmentier D. Evaluation of the uterine cervix by intravaginal ultrasonography prior to prostaglandin gel maturation. Revue française de gynécologie et d'obstétrique 1998;93:106- 10.

16. Paterson-Brown S, Fisk NM, Edmonds DK, Rodeck CH. Preinduction cervical assessment by Bishop’s score and transvaginal ultrasound. Eur J Obstet Gynecol Reprod Biol 1991;40:17-23. [ Crossref ] [ PubMed ] Pitarello Pda R, Tadashi Yoshizaki C, Ruano R, Zugaib M. Prediction of successful labor induction using transvaginal sonographic cervical measurements. J Clin Ultrasound 2013;41:76-83. [ Crossref ] [ PubMed ] Rane SM, Guirgis RR, Higgins B, Nicolaides KH. Pre- induction sonographic measurement of cervical length in prolonged pregnancy: the effect of parity in the prediction of the need for Cesarean section. Ultrasound Obstet Gynecol 2003;22:45-8. [ Crossref ] [ PubMed ] Rathore A, Sharma R, Kar R, Tandon A, Suneja A, Guleria K. Role of Cervical Phosphorylated Insulin- Like Growth Factor- Binding Protein 1 (phIGFBP1) for Prediction of Successful Induction Among Primigravida with Prolonged Pregnancy. J Obstet Gynaecol India 2021;71:38-44. [ Crossref ] [ PubMed ] Reis FM, Gervasi MT, Florio P, Bracalente G, Fadalti M, Severi FM, Petraglia F. Prediction of successful induction of labor at term: role of clinical history, digital examination, ultrasound assessment of the cervix, and fetal fibronectin assay. Am J Obstet Gynecol 2003;189:1361-7. [ Crossref ] [ PubMed ] Roman H, Verspyck E, Vercoustre L, Degre S, Col JY, Firmin JM, Caron P, Marpeau L. Does ultrasound examination when the cervix is unfavorable improve the prediction of failed labor induction? Ultrasound Obstet Gynecol 2004;23:357-62. [ Crossref ] [ PubMed ]

17. Study Title: Study number: Subject Name: Subject Age: I confirm that I have read and understood the information sheet dated for the above study. I had the opportunity to ask questions and all the questions were answered to my satisfaction. I understand that my participation in the study is voluntary and that I am free to withdraw at any time without giving any reason, without my medical care or legal rights being affected. I understand that the investigator and the ethics committee will not need my permission to look at my health records both in respect of the current study and any further research that may be conducted in relation to it, even if I withdraw from the study. I agree to this access. However I understand that my identity will not be revealed in any information released to third parties or published. I agree not to restrict the use of any data or results that arise from this study provided that such a use is only for scientific purpose. I agree to take part in the above study Signature (or thumb impression) of the subject Date: Signatory name: Signature of the Legally Accepted Representative Date: Signatory name: Signature of the investigator Date Study investigator name: Signature of the witness: Date: INFORMED CONSENT

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20. Methodology Transvaginal Ultrasound will be performed and posterior cervical angle will be measured before induction of labour in the labourward Cervical assessment by digital examination and bishop score calculation will be done before induction of labour in the labour ward Gynecologist experienced in Transvaginal ultrasound will be doing both the posterior cervical angle measurement and Bishop’s score calculation Posterior cervical angle more than 90 degrees and Bishop score of more than or equal to 8 is considered as favourable for prediction of vaginal delivery Successful vaginal delivery and labour induction outcomes will be noted The outcomes will be compared