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Insulin-like growth factor binding protein 1, Bishop score, and sonographic cervical length: tolerability and prediction of vaginal birth and vaginal birth within 24 hours following labour induction in nulliparous women

Objective: To evaluate the tolerability of cervical insulin-like growth factor binding protein 1 (IGFBP-1) and its value as a predictor of successful labour induction, compared with Bishop score and transvaginal ultrasound (TVUS) cervical length. Design: A prospective study. Setting: A tertiary hosp...

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Main Authors: Vallikkannu, Narayanan, Lam, W.K., Omar, Siti Zawiah, Tan, Peng Chiong
Format: Article
Published: Wiley 2016
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R Medicine
Online Access:http://eprints.um.edu.my/22854/
https://doi.org/10.1111/1471-0528.14175
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spelling my.um.eprints.228542019-10-26T03:40:09Z http://eprints.um.edu.my/22854/ Insulin-like growth factor binding protein 1, Bishop score, and sonographic cervical length: tolerability and prediction of vaginal birth and vaginal birth within 24 hours following labour induction in nulliparous women Vallikkannu, Narayanan Lam, W.K. Omar, Siti Zawiah Tan, Peng Chiong R Medicine Objective: To evaluate the tolerability of cervical insulin-like growth factor binding protein 1 (IGFBP-1) and its value as a predictor of successful labour induction, compared with Bishop score and transvaginal ultrasound (TVUS) cervical length. Design: A prospective study. Setting: A tertiary hospital in Malaysia. Population: A cohort of 193 term nulliparous women with intact membranes. Methods: Prior to labour induction, cervical fluid was obtained via a vaginal speculum and tested for IGFBP-1, followed by TVUS and finally Bishop score. After each assessment the procedure-related pain was scored from 0 to 10. Cut-off values for Bishop score and cervical length were obtained from the receiver operating characteristic (ROC) curve. Multivariable logistic regression analysis was performed. Main outcomes measures: Vaginal delivery and vaginal delivery within 24 hours of starting induction. Results: Bedside IGFBP-1 testing is better tolerated than Bishop score, but is less well tolerated than TVUS [median (interquartile range) of pain scores: 5 (4–5) versus 6 (5–7) versus 3 (2–3), respectively; P < 0.001]. IGFBP-1 independently predicted vaginal delivery (adjusted odds ratio, AOR 5.5; 95% confidence interval, 95% CI 2.3–12.9) and vaginal delivery within 24 hours of induction (AOR 4.9; 95% CI 2.1–11.6) after controlling for Bishop score (≥4 or ≥5), cervical length (≤29 or ≤27 mm), and other significant characteristics for which the Bishop score and TVUS were not predictive of vaginal delivery after adjustment. IGFBP-1 has 81% sensitivity, 59% specificity, positive and negative predictive values of 82 and 58%, respectively, and positive and negative likelihood ratios of 2.0 and 0.3 for vaginal delivery, respectively. Conclusion: IGFBP-1 better predicted vaginal delivery than BS or TVUS, and may help guide decision making regarding labour induction in nulliparous women. Tweetable abstract: IGFBP-1: a stronger independent predictor of labour induction success than Bishop score or cervical sonography. Wiley 2016 Article PeerReviewed Vallikkannu, Narayanan and Lam, W.K. and Omar, Siti Zawiah and Tan, Peng Chiong (2016) Insulin-like growth factor binding protein 1, Bishop score, and sonographic cervical length: tolerability and prediction of vaginal birth and vaginal birth within 24 hours following labour induction in nulliparous women. BJOG: An International Journal of Obstetrics & Gynaecology, 124 (8). pp. 1274-1283. ISSN 1470-0328 https://doi.org/10.1111/1471-0528.14175 doi:10.1111/1471-0528.14175
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine
spellingShingle R Medicine
Vallikkannu, Narayanan
Lam, W.K.
Omar, Siti Zawiah
Tan, Peng Chiong
Insulin-like growth factor binding protein 1, Bishop score, and sonographic cervical length: tolerability and prediction of vaginal birth and vaginal birth within 24 hours following labour induction in nulliparous women
description Objective: To evaluate the tolerability of cervical insulin-like growth factor binding protein 1 (IGFBP-1) and its value as a predictor of successful labour induction, compared with Bishop score and transvaginal ultrasound (TVUS) cervical length. Design: A prospective study. Setting: A tertiary hospital in Malaysia. Population: A cohort of 193 term nulliparous women with intact membranes. Methods: Prior to labour induction, cervical fluid was obtained via a vaginal speculum and tested for IGFBP-1, followed by TVUS and finally Bishop score. After each assessment the procedure-related pain was scored from 0 to 10. Cut-off values for Bishop score and cervical length were obtained from the receiver operating characteristic (ROC) curve. Multivariable logistic regression analysis was performed. Main outcomes measures: Vaginal delivery and vaginal delivery within 24 hours of starting induction. Results: Bedside IGFBP-1 testing is better tolerated than Bishop score, but is less well tolerated than TVUS [median (interquartile range) of pain scores: 5 (4–5) versus 6 (5–7) versus 3 (2–3), respectively; P < 0.001]. IGFBP-1 independently predicted vaginal delivery (adjusted odds ratio, AOR 5.5; 95% confidence interval, 95% CI 2.3–12.9) and vaginal delivery within 24 hours of induction (AOR 4.9; 95% CI 2.1–11.6) after controlling for Bishop score (≥4 or ≥5), cervical length (≤29 or ≤27 mm), and other significant characteristics for which the Bishop score and TVUS were not predictive of vaginal delivery after adjustment. IGFBP-1 has 81% sensitivity, 59% specificity, positive and negative predictive values of 82 and 58%, respectively, and positive and negative likelihood ratios of 2.0 and 0.3 for vaginal delivery, respectively. Conclusion: IGFBP-1 better predicted vaginal delivery than BS or TVUS, and may help guide decision making regarding labour induction in nulliparous women. Tweetable abstract: IGFBP-1: a stronger independent predictor of labour induction success than Bishop score or cervical sonography.
format Article
author Vallikkannu, Narayanan
Lam, W.K.
Omar, Siti Zawiah
Tan, Peng Chiong
author_facet Vallikkannu, Narayanan
Lam, W.K.
Omar, Siti Zawiah
Tan, Peng Chiong
author_sort Vallikkannu, Narayanan
title Insulin-like growth factor binding protein 1, Bishop score, and sonographic cervical length: tolerability and prediction of vaginal birth and vaginal birth within 24 hours following labour induction in nulliparous women
title_short Insulin-like growth factor binding protein 1, Bishop score, and sonographic cervical length: tolerability and prediction of vaginal birth and vaginal birth within 24 hours following labour induction in nulliparous women
title_full Insulin-like growth factor binding protein 1, Bishop score, and sonographic cervical length: tolerability and prediction of vaginal birth and vaginal birth within 24 hours following labour induction in nulliparous women
title_fullStr Insulin-like growth factor binding protein 1, Bishop score, and sonographic cervical length: tolerability and prediction of vaginal birth and vaginal birth within 24 hours following labour induction in nulliparous women
title_full_unstemmed Insulin-like growth factor binding protein 1, Bishop score, and sonographic cervical length: tolerability and prediction of vaginal birth and vaginal birth within 24 hours following labour induction in nulliparous women
title_sort insulin-like growth factor binding protein 1, bishop score, and sonographic cervical length: tolerability and prediction of vaginal birth and vaginal birth within 24 hours following labour induction in nulliparous women
publisher Wiley
publishDate 2016
url http://eprints.um.edu.my/22854/
https://doi.org/10.1111/1471-0528.14175
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score 13.211869

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