THE ASSOCIATION BETWEEN CERVICAL SONOGRAPHY AND SUCCESSFUL INDUCTION OF LABOR: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Many sonographic assessments of the cervix have been introduced to assess pre-induction cervical ripening for vaginal delivery (VD). However, the association between existing cervical assessments and successful VD remains unclear. This systematic review was conducted to estimate and compare the association between existing cervical assessments and successful VD in pregnant women who underwent induction of labor (IOL). Related studies were identified from PubMed, EMBASE, and Scopus from inception to July 2022. A multi-level mixed-effects logistic regression model was applied to estimate the odds ratio (OR) of successful VD and compare association among cervical assessments by relative ORs. A total of 86 studies which comprised 13,797 patients were included. The results showed that all cervical assessments (i.e., cervical length (CL), cervical wedging, cervical funneling, cervical elastography, uterocervical angle (UCA), and cervical volume) had a significant association with VD with OR (95% confidence interval (CI) of 4.89 (4.41, 5.42), 2.68 (2.16, 3.32), 1.63 (1.10, 2.43), 1.70 (1.12, 2.57), 4.52 (3.57, 6.72), and 6.13 (2.57, 14.62), respectively. The cervical volume was the highest association with a relative OR of 1.26 (0.52, 3.01) when compared with CL, but non-statistical significance. The rest of the cervical assessments showed lower association when compared with CL.