A PEER-REVIEWED JOURNAL OF RESEARCH AND CLINICAL MEDICINEISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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Clinical and Elastographic Assessment of Immature Vesical Cervix Preparations for Delivery

DOI:10.31550/1727-2378-2019-166-11-22-28
For citation: Pekarev O.G., Brega E.S., Lunkov S.S., Gus A.I. Clinical and Elastographic Assessment of Immature Vesical Cervix Preparations for Delivery. Doctor.Ru. 2019; 11(166): 22–28. DOI: 10.31550/1727-2378-2019-166-11-22-28

Study Objective: to perform a comprehensive assessment of the efficiency of a combined method to prepare vesical cervix for delivery using DILAPAN-S dilatators together with oral mifepristone.
Study Design: prospective cohort study.
Materials and Methods: the study enrolled 200 pregnant women aged 23-38 years old with soft birth canal unprepared for delivery and indications for delivery pre-induction.50 women (group 1) had their vesical cervix prepared for delivery using DILAPAN-S — 4 dilatators inserted for up 12 hours, together with oral mifepristone 200 mg twice with a 24-hour interval. DILAPAN-S were inserted together with the second mifepristone dose. Group 2 included 50 pregnant women, vesical cervix of which was prepared using 4 DILAPAN-S dilatators only.50 patients in group 3 prepared for delivery with Foley catheter inserted for up 12 hours. Group 4 (50 patients) had their birth canal prepared for delivery using intracervical gel containing Е2 (0.5 mg) twice with a 6-hour interval. Vesical cervix maturity was assessed using Bishop’s scale and ultrasound examination.
For the study, all patients were divided into three sub-groups depending on their vesical cervix maturity (Bishop’s scale) prior to delivery pre-induction. Sub-group А (n = 66) included patients with their vesical cervix maturity of 0–2 points; sub-group B (n = 69) — 3–4 points; sub-group C (n = 65) — 4–6 points. 10 patients from each group were randomly selected to assess their vesical cervix density prior to and after pre-induction using sonoelastography.
Study Results: the most efficient was the method combining DILAPAN-S dilatators and oral mifepristone: 11.4 ± 0.21 points (Bishop’d sacle) vs. 10.2 ± 0.2, 9.4 ± 0.3, and 9.67 ± 0.25 in group 2, 3 and 4, respectively (p < 0.05 in all cases). The lowest Strain Ratio was recoded in patients with combined pre-induction: 1.23 ± 0.04 vs. 1.63 ± 0.07, 1.7 ± 0.08, and 1.83 ± 0.1 (p < 0.05 in all cases).
DILAPAN-S insertion in combination with oral mifepristone in group 1B was not advantageous if compared with DILAPAN-S only in group 2B (11.3 ± 0.42 and 10.3 ± 0.26 points), thus mifepristone may be not used in pregnant women with initially immature vesical cervix of 3–4 points.
Conclusion: combined therapy with DILAPAN-S and mifepristone is more efficient versus all other methods to prepare vesical cervix for birth. Efficiency of this method is confirmed both by subjective assessment of vesical cervix maturity (Bishop’d scale) and more objective assessment using sonoelastography to identify the colour elastotype and Strain Ratio calculations.

O.G. Pekarev — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 8752-7457. E-mail: o_pekarev@oparina4.ru

E.S. Brega — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. E-mail: e_brega@oparina4.ru

S.S. Lunkov — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 9587-2340. E-mail: s_lunkov@oparina4.ru

A.I. Gus — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 1464-2786. E-mail: a_gus@oparina4.ru

Contribution: Pekarev O.G. — patient management, study design, review of critically important material, approval of the final article version; Brega E.S. — a set of clinical material, thematic publications reviewing; Lunkov S.S. — data collection and interpretation, thematic publications reviewing; Gus A.I. — review of critically important material, approval of the final article version, approval of the manuscript for publication.

The authors declare that they do not have any conflict of interests.

Доктор.ру
LITERATURE
  1. Vogel J.P., Betrán A.P., Vindevoghel N., Souza J.P., Torloni M.R., Zhang J. et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob. Health. 2015; 3(5): e260–70. DOI: 10.1016/S2214-109X(15)70094-X
  2. Брега Е.С., Сахарова Г.В., Пекарев О.Г. Результаты применения комбинированного метода подготовки шейки матки к родам. Акушерство и гинекология. 2017; 11: 37–43. [Brega E.S., Sakharova G.V., Pekarev O.G. Rezul'taty primeneniya kombinirovannogo metoda podgotovki sheiki matki k rodam. Akusherstvo i ginekologiya. 2017; 11: 37–43. (in Russian)]
  3. Брега Е.С., Пекарев О.Г. Варианты подготовки шейки матки к родам. Акушерство и гинекология. 2017; 7: 136–9. [Brega E.S., Pekarev O.G. Varianty podgotovki sheiki matki k rodam. Akusherstvo i ginekologiya. 2017; 7: 136–9. (in Russian)]
  4. Baev O.R., Rumyantseva V.P., Tysyachnyu O.V., Kozlova O.A., Sukhikh G.T. Outcomes of mifepristone usage for cervical ripening and induction of labour in full-term pregnancy. Randomized controlled trial. Eur. J. Obstet. Gynecol. Reprod. Biol. 2017; 217: 144–9. DOI: 10.1016/j.ejogrb.2017.08.038
  5. Баев О.Р., Румянцева В.П., Кан Н.Е., Тетруашвили Н.К., Тютюнник В.Л., Ходжаева З.С. и др. Подготовка шейки матки к родам и родовозбуждение. Клинический протокол. Акушерство и гинекология. 2012; 4/2: 1–16. [Baev O.R., Rumyantseva V.P., Kan N.E., Tetruashvili N.K., Tyutyunnik V.L., Khodzhaeva Z.S. i dr. Podgotovka sheĭki matki k rodam i rodovozbuzhdenie. Klinicheskiĭ protokol. Akusherstvo i ginekologiya. 2012; 4/2: 1–16. (in Russian)]
  6. Chen W., Xue J., Peprah M.K., Wen S.W., Walker M., Gao Y. et al. A systematic review and network meta-analysis comparing the use of Foley catheters, misoprostol, and dinoprostone for cervical ripening in the induction of labour. BJOG. 2016; 123(3): 346–54. DOI: 10.1111/1471-0528.13456
  7. Bishop E.H. Pelvic scoring for elective induction. Obstet. Gynecol. 1964; 24: 266–8.
  8. Wormer K.C., Williford A.E. Bishop Score. StatPearls. 2019. URL: https:// www.ncbi.nlm.nih.gov/books/NBK470368/ (дата обращения — 15.03.2019).
  9. National Collaborating Centre for Women’s, Children’s HealthInduction of labour. Evidence-based Clinical Guideline. 2nd ed. London: RCOG Press; 2008. 104 p.
  10. Londero A.P., Schmitz R., Bertozzi S., Driul L., Fruscalzo A. Diagnostic accuracy of cervical elastography in predicting labor induction success: a systematic review and meta-analysis. J. Perinat. Med. 2016; 44(2): 167–78. DOI: 10.1515/jpm-2015-0035
  11. Fruscalzo A., Mazza E., Feltovich H., Schmitz R. Cervical elastography during pregnancy: a critical review of current approaches with a focus on controversies and limitations. J. Med. Ultrason. (2001). 2016; 43(4): 493–504. DOI: 10.1007/s10396-016-0723-z
  12. Зыкин Б.И., Постнова Н.А., Медведев М.Е. Ультразвуковая эластография. Мед. алфавит. 2013; 1–2(10): 14–9. [Zykin B.I., Postnova N.A., Medvedev M.E. Ul'trazvukovaya elastografiya. Med. alfavit. 2013; 1–2(10): 14–9. (in Russian)]
  13. Hatfield A.S., Sanchez-Ramos L., Kaunitz A.M. Sonographic cervical assessment to predict the success of labor induction: a systematic review with metaanalysis. Am. J. Obstet. Gynecol. 2007; 197(2): 186–92. DOI: 10.1016/j.ajog.2007.04.050
  14. Hernandez-Andrade E., Romero R., Korzeniewski S.J., Ahn H., Aurioles-Garibay A., Garcia M. et al. Cervical strain determined by ultrasound elastography and its association with spontaneous preterm delivery. J. Perinat. Med. 2014; 42(2): 159–69. DOI: 10.1515/jpm-2013-0277
  15. Sabiani L., Haumonte J.-B., Loundou A., Caro A.-S., Brunet J., Cocallemen J.-F. et al. Cervical HI-RTE elastography and pregnancy outcome: a prospective study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2015; 186: 80–4. DOI: 10.1016/j.ejogrb.2015.01.016
  16. Fruscalzo A., Londero A.P., Fröhlich C., Meyer-Wittkopf M., Schmitz R. Quantitative elastography of the cervix for predicting labor induction success. Ultraschall Med. 2015; 36(1): 65–73. DOI: 10.1055/s-0033-1355572
  17. Hee L., Rasmussen C.K., Schlütter J.M., Sandager P., Uldbjerg N. Quantitative sonoelastography of the uterine cervix prior to induction of labor as a predictor of cervical dilation time. Acta Obstet. Gynecol. Scand. 2014; 93(7): 684–90. DOI: 10.1111/aogs.12389
  18. Осипов Л.В. Ультразвуковые диагностические приборы: режимы, методы и технологии. М.: Изомед; 2011. 316 с. [Osipov L.V. Ul'trazvukovye diagnosticheskie pribory: rezhimy, metody i tekhnologii. M.: Izomed; 2011. 316 s. (in Russian)]
  19. Doyley M.M., Meaney P.M., Bamber J.C. Evaluation of an iterative reconstruction method for quantitative elastography. Phys. Med. Biol. 2000; 45(6): 1521–40.
  20. Doherty J.R., Trahey G.E., Nightingale K.R., Palmeri M.L. Acoustic radiation force elasticity imaging in diagnostic ultrasound. IEEE Trans. Ultrason. Ferro­electr. Freq. Control. 2013; 60(4): 685–701. DOI: 10.1109/TUFFC.2013.2617
  21. Varghese T. Quasi-static ultrasound elastography. Ultrasound Clin. 2009; 4(3): 323–38. DOI: 10.1016/j.cult.2009.10.009
  22. Papadacci C., Bunting E.A., Konofagou E.E. 3D Quasi-static ultrasound elastography with plane wave in vivo. IEEE Trans. Med. Imaging. 2017; 36(2): 357–65. DOI: 10.1109/TMI.2016.2596706
  23. Ophir J., Alam S.K., Garra B.S., Kallel F., Konofagou E.E., Krouskop T. et al. Elastography: imaging the elastic properties of soft tissues with ultrasound. J. Med. Ultrason. (2001). 2002; 29(4): 155. DOI: 10.1007/BF02480847

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