Ultrasonography cervical volume as a predictor of successful induction of labor: a systematic review and meta-analysis
https://doi.org/10.47093/2218-7332.2025.1223
摘要
Aim. To compare the cervical volume of patients who underwent successful and failed induction of labor (IOL) procedures.
Materials and methods. This systematic review and meta-analysis were conducted according to PRISMA guidelines. A comprehensive literature search was performed in PubMed, EMBASE, Scopus, and Google Scholar to identify cohort studies published between January 01, 2005 and December 31, 2024, that compared cervical volume in pregnant women who underwent IOL. A random-effects meta-analysis was performed.
Results. Seven studies involving 534 pregnant women were included. Four studies were considered low risk of bias and two studies were regarded as high risk of bias. Risk of bias assessment could not be performed in one study because the full-text of the article was not available. The pooled analysis of two studies involving 168 pregnant women demonstrated a positive association between the lower cervical volume and successful vaginal delivery within 24 hours (odds ratio 7.19; 95% confidence interval: 3.31 to 15.64; I² = 0%). The pooled analysis of five studies involving 422 pregnant women showed no statistically significant difference between successful and failed IOL, with a mean difference –1.32 cm3; 95% confidence interval: –8.37 to 5.72; I² = 89.8%). Subgroup analyses showed no statistically significant association between cervical volume and successful IOL when defined as vaginal delivery without time restriction or within 24 hours. However, a significantly lower cervical volume was observed in women who achieved the active phase of labor within 12 hours. The Egger’s regression test confirmed the absence of small‑study effects (coefficient = 0.50, standard error = 1.75, p = 0.78).
Conclusion. Cervical volume has significant potential as a parameter for predicting successful IOL, with a smaller cervical volume being associated with better outcomes, although subgroup findings remain inconsistent.
关于作者
P. Kassayanan
Srinakharinwirot University
泰国
泰国
K. Nontaprom
Srinakharinwirot University
泰国
泰国
P. Chantabal
Khlong Luang Hospital
泰国
泰国
S. Thanasantumrongsak
Srinakharinwirot University
泰国
泰国
M. Suntipap
Srinakharinwirot University
泰国
泰国
参考
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Sechenov Medical Journal. Editor's checklist for this article you can find here.
Название / Title | Объем шейки матки, оцененный по ультразвуковому исследованию, как предиктор успешной родовой деятельности: систематический обзор и метаанализ / Ultrasonography cervical volume as a predictor of successful induction of labor: a systematic review and meta-analysis |
Раздел / Section
| АКУШЕРСТВО И ГИНЕКОЛОГИЯ / ОBSTETRICS AND GYNECOLOGY |
Тип / Article | Систематический обзор / Systematic review |
Номер / Number | 1223
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Страна/территория / Country/Territory of origin | Таиланд / Thailand |
Язык / Language | Английский / English
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Источник / Manuscript source | Инициативная рукопись / Unsolicited manuscript |
Дата поступления / Received | 30.04.2025 |
Тип рецензирования / Type ofpeer-review | Двойное слепое / Double blind |
Язык рецензирования / Peer-review language | Английский / English |
РЕЦЕНЗЕНТ А / REVIEWER A
Инициалы / Initials | 1223_А
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Научная степень / Scientific degree | Кандидат медицинских наук / Cand. of Sci. (Medicine)
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Страна/территория / Country/Territory | Россия / Russia
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Дата рецензирования / Date of peer-review | 30.06.2025
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Число раундов рецензирования / Number of peer-review rounds | 2 |
Финальное решение / Final decision | принять к публикации / accept
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ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW
Scientific quality: Grade B: Good
Language quality: Grade B (Minor language polishing)
Re-review: Yes
This meta-analysis addresses a clinically important question: identifying predictors of successful induction of labor to reduce maternal and fetal risks. The study design is robust, adhering to PRISMA guidelines and PROSPERO registration, with a comprehensive search across databases. The inclusion of seven prospective cohort studies and subgroup analysesfor varying definitions of success strengthens its relevance to clinical decision-making.
Comments
1) association between cervical volume and IOL success reverses direction depending on outcome timing (smaller volume linked to success in some subgroups, larger in others), creating conflicting conclusions. This issue should be thoroughly addressed in limitations and discussion.
2) Results of Deeks’ funnel plot and Egger’s test are mentioned but not reported, limiting assessment of potential bias.
3) High heterogeneity (Heterogeneity Index up to 89%) and inclusion of only seven studies weaken confidence in pooled estimates. Authors encouraged to address this issue in limitations.
4) Two studies rated as high risk, and geographic diversity is limited (most from Asia), raising concerns about generalizability.
5) The abstract/conclusion emphasizes smaller cervical volume as beneficial despite conflicting subgroup results.
Recommendation after the first round of peer-review: major revision and re-review.
ВТОРОЙ РАУНД РЕЦЕНЗИРОВАНИЯ /SECOND ROUND OF PEER-REVIEW
All comments have been addressed by authors.
РЕЦЕНЗЕНТ B / REVIEWER B
Инициалы / Initials | 1223_В
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Научная степень / Scientific degree | Кандидат медицинских наук / Cand. of Sci. (Medicine)
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Страна/территория / Country/Territory | Россия / Russia
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Дата рецензирования / Date of peer-review | 30.05.2025 |
Число раундов рецензирования / Number of peer-review rounds | 1 |
Финальное решение / Final decision | Принять к публикации после небольшой доработки/ Minor revision
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ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW
Scientific quality: Grade B: Good
Language quality: Grade B (Minor language polishing)
Re-review: No
The authors conducted a high-quality systematic review and meta-analysis. Its methodology and composition raises only a few minor issues:
Q1. Line 429. The sentence “The modified NOS evaluated six studies but limited data for
diagnostic perfor-mance evaluation using the QUADAS-2 tool” is not quite clear. The authors are suggested to rephrase it and to detail why this tool was not applicable.
Q2. The authors may consider re-structuring the manuscript: risk of bias seems to be more appropriate after the section “Characteristics of included studies”. Table 4 may be moved to supplementary material as this data is shown at Figure 3.
РЕКОМЕНДАЦИИ НАУЧНЫХ РЕДАКТОРОВ ЖУРНАЛА / RECOMMENDATIONS
OF THE SCIENTIFIC EDITORS OF THE JOURNAL
Main text
- To ensure that the main findings, clinical relevance and novelty of the study are clearly and concisely communicated to the reader, it is necessary to add three to five key highlights of the paper. These highlights improve the article’s visibility and facilitate rapid appraisal by clinicians and researchers conducting focused literature searches.
- A traffic light plot for the risk-of-bias assessment should be provided, as this visual representation allows readers and reviewers to easily evaluate the methodological quality of the included studies. This is an essential element of high-quality systematic reviews, contributing to greater transparency and reproducibility of the findings.
- Funnel plots and the results of Egger’s test must be included to assess potential publication bias. These analyses strengthen the credibility and robustness of the meta-analysis, demonstrating that the authors have critically evaluated the risk of systematic distortion in the available evidence.
Technical requirements
- To ensure transparency, accountability, and accurate indexation in scientific databases, including PubMed, it is necessary to provide full information for all authors, including academic degree and title (if applicable), position, and place of work (or study). Providing complete author details also ensures compliance with international publication standards, including the recommendations of the International Committee of Medical Journal Editors (ICMJE).
- Submitting all figures as separate, high-quality files ensures clear and accurate visualization in both the online and print versions of the journal. Low-resolution or poor-quality images may compromise readability, reduce the scientific value of the article and affect its suitability for indexing negatively.
- It is essential to provide Figure 1 in an editable format (e.g. PPTX) rather than as a screenshot to ensure professional layout and consistent formatting. Editable files allow technical adjustments to be made during the production process, whereas screenshots cannot be modified without loss of quality.
- The reference list must be formatted in accordance with Vancouver style to ensure consistency, a professional presentation, accurate database indexing and compliance with the journal's editorial policy and international standards.
- Providing the DOI and PMID (if available) for each reference is essential to facilitate accurate indexing in international databases, enabling readers to locate the original sources efficiently, a key requirement of high-quality scientific publishing.
References
- To reflect the current state of knowledge and ensure that the review is based on the most up-to-date and relevant evidence, it is necessary to add recent studies to the reference list, with the majority of references preferably published within the last five years.
- As most of the included studies originate from Asia, it is important to clarify whether this topic has been investigated in other regions. The geographic diversity of the included studies should be increased, or a clear justification for the current regional focus should be provided. Overrepresentation of a single region may introduce geographical or population bias, limiting the generalizability of the conclusions. Addressing this issue would significantly strengthen the study's scientific validity.
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