Bishop Score Aka: Bishop Score

Advertisement 1.Scoring 1.Cervical Dilation 1.Cervix dilated < 1 cm: 0 2.Cervix dilated 1-2 cm: 1 3.Cervix dilated 2-4 cm: 2 4.Cervix dilated > 4 cm: 3

2.

Cervical Length (Effacement)

1.

Cervical Length > 4 cm (0% effaced): 0 Cervical Length 2-4 cm (0 to 50% effaced): 1 Cervical Length 1-2 cm (50 to 75% effaced): 2 Cervical Length < 1 cm (>75% effaced): 3

2.

3.

4.

3.Cervical Consistency 1.Firm cervical consistency: 0 2.Average cervical consistency: 1 3.Soft cervical consistency: 2 4.Cervical Position

1.Posterior cervical position: 0 2.Middle or anterior cervical position: 1 5.Zero Station Notation (presenting part level)
1.

Presenting part at ischial spines -3 cm: 0 Presenting part at ischial spines -1 cm: 1 Presenting part at ischial spines +1 cm: 2 Presenting part at ischial spines +2 cm: 3

2.

3.

4.

2.Modifiers 1.Add 1 point to score for:

1.

Preeclampsia

2.

Each prior Vaginal Delivery

2.Subtract 1 point from score for:

1.

Postdates Pregnancy

2.Nulliparity
3.

Premature or prolonged Rupture of Membranes

3.Interpretation
1.

Indications for Cervical Ripening with prostaglandins 1.Bishop Score <5 2.Membranes intact 3.No regular contractions

2.

Indications for Labor Induction with Pitocin 1.Bishop Score >= 5

2.

Rupture of Membranes

Components
The total score is achieved by assessing the following five components on vaginal examination: The Bishop score grades patients who would be most likely to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score; a score that exceeds 8 describes the patient most likely to achieve a successful vaginal birth. Bishop scores of less than 6 usually require that a cervical ripening method be used before other methods.

Cervical dilation

 Cervical effacement Cervical consistency Cervical position

Fetal station

They can be remembered with the mnemonic: Call PEDS For Parturition = Cervical Position, Effacement, Dilation, Softness; Fetal Station.

[edit] Scoring
Each components is given a score of 0-2 or 0-3. The highest possible score is 13.
Bishop score Paramete r\Score 0 1 2 3 Description

Position Posterio Intermedi Anterio r ate r

The position of the cervix varies between individual women. As the anatomical location of the vagina is actually downward facing, anterior and posterior

locations relatively describe the upper and lower borders of the vagina. The anterior position is better aligned with the uterus, and therefore there is an increased likelihood of spontaneous delivery. Consisten Firm cy Intermedi Soft ate In primigravid women the cervix is typically tougher and resistant to stretching, much like a balloon that has not been previously inflated. Furthermore, in young women the cervix is

more resilient than in older women. With subsequent vaginal deliveries the cervix becomes less rigid and allows for easier dilation at term. Effaceme 0-30% nt 31-50% 51-80% >80 Effacement is a % measure of stretch already present in the cervix. It is analogous to stretching a rubber band; as the rubber band is stretched further, it becomes thinner. This is affected by individual variation

and previous surgery such as loop excision for cervical dysplasia or cancer. Dilation 0 cm 12 cm 34 cm >5 Dilation is a measure of cm the diameter of the stretched cervix. It complements effacement, and is usually the most important indicator of progression through the first stage of labour. -1, 0 +1, Fetal station describes +2 the position in of the foetus' head in relation

Fetal station

-3

-2

to the distance from the ischial spines, which can be palpated deep inside the posterior vagina (approximately 8 10 cm) as a bony protrusion. Negative numbers indicate that the head is further inside, above the ischial spines.

[edit] Interpretation
A score of 5 or less suggests that labour is unlikely to start without induction. A score of 9 or more indicates that labour will most likely commence spontaneously.[3]

A low Bishop's score often indicates that induction is unlikely to be successful.[4] Some sources indicate that only a score of 8 or greater is reliably predictive of a successful induction.

[edit] Modified Bishop score

According to the Modified Bishop's pre-induction cervical scoring system, effacement has been replaced by cervical length in cm, with scores as follows- 0>3 cm, 1>2 cm, 2>1 cm, 3>0 cm.[5] Another modification for the Bishop's score is the modifiers. Points are added or subtracted according to special circumstances as follows: One point is added for:

1. Existence of pre-eclampsia

 2. Every previous vaginal delivery One point is subtracted for: 1. Postdate pregnancy

2. Nulliparity (no previous vaginal deliveries) 3. PPROM (premature preterm rupture of membranes)