Bishop Score

1. CNE ON BISHOP’S SCORE
By
Dr. Shanthi Ida, Date : 29/10/2021
Professor & HOD OBG (N) Class room
SNSR, Sharda University,
Greater Noida, U.P.
Sharda Hospital

3. BISHOP SCORE
The Bishop score is a system used by medical professionals to
decide how likely it is that patient will go into labor soon. They use
it to determine whether they should recommend induction, and
how likely it is that an induction will result in a vaginal birth.

4. INTRODUCTION
 The induction delivery or accelerated delivery (Induction of labor) is to encourage
pregnancy. giving birth by causing the uterus to contract together with softening the
cervix to enter the birthing process.
 Bishop Score was assessed as a predictor of the success of induction. The results of the
examination of the preamble and cervix were evaluated as a score. which has a total of
13 full marks
 In 1964, Edward Bishop set forth criteria for elective induction of labor which included
parity, gestational age, fetal presentation, obstetric history, and patient consent as well as
a scoring system for the cervix to help predict successful induction of labor.

5. EXTENSIVE CERVICAL REMODELING IS NEEDED FOR THE CERVIX TO DILATE AND PASS A FETUS
FULLY
nonpregnant cervix
Inflammatory
mediators in pregnancy
Increase of
prostaglandins
release of
metalloproteases
break down collagen
increased vascularity
stromal and glandular
hypertrophy
decreased collagen
density
increase in hyaluronic
acid and water
content.
In pregnancy Cervical
softening and
distention
Anatomy &
physiology of
cervical ripening

7. UNDERSTANDING SCORE
 The Bishop scoring system is based on a digital cervical exam of a patient with
a zero point minimum and 13 point maximum. The scoring system utilizes
cervical dilation, position, effacement, consistency of the cervix, and fetal
station. Cervical dilation, effacement, and station are scored 0 to 3 points,
while cervical position and consistency are scored 0 to 2 point
 The higher the score Indicates the suitability of the condition of the
cervix that is ready to go into labor. And the stimulation will be easily
accomplished
 Divided into 5 parts.

9. 1. Dilation of the cervix dilation (centimeters)
 This means how far your cervix has opened in centimetres.
 cervix closed - 0 points
 The cervix was open 1-2 cm - given 1 point.
 Cervical opening 3-4 cm - score 2 points.
 Cervical opening 5-6 cm - 3 points

12. 2.EFFACEMENTOF THE CERVIX
 This means how thin your cervix is. It is normally about 3 centimeters
long. It gradually becomes thinner as labor progresses.
 Cervical Effacement Thinness (%)
 0-30 percent give 0 points
 40-50 percent give 1 point
 60-70 percent give 2 points
 80% or more, 3 points

14. 3.CONSISTENCYOF THE CERVIX
This means whether your cervix feels soft or firm. Women who have had previous
pregnancies usually have a softer cervix. The cervix softens before labour
 Softness of the cervix Cervical consistency
 Cervix is hard, 0 points.
 Medium soft cervix: 1 point
 Soft cervix: 2 points

16. 4.POSITIONOF THE CERVIX
 As the baby descends into the pelvis, the cervix — the doorway to the
uterus — moves forward with the head and the uterus.
 Position of the cervix
 The back gives 0 points.
 The center gives 1 point.
 Front gives 2 points.

18. 5.FETAL STATION
This is how far up the birth canal the baby’s head is. Usually, before labor begins,
the baby’s head moves from –5 (high up and not yet in the pelvis) to station 0 (where the
baby’s head is firmly in the pelvis). During labor the baby moves through the vaginal
canal until the head is clearly visible (+5) and the baby is about to be delivered.
 Station -3 (lead is 3 cm above ischial spine level) 0 points
 Station -2 (lead is 2 cm above ischial spine level) 1 point
 Station -1 or 0 (lead is at the same level or higher than ischial spine 1 cm) score 2
 Station +1 or +2 (lead is 1-2 cm below the ischial spine level) = 3 points

20. Bishop Score Scoring
 A score of 9 or more is considered favorable cervix with a high chance of induction success.
 Below 4 the cervix is considered unfavorable cervix, there is no chance of success in inducing labor.
 If your Bishop score is high, it means that there’s a greater chance that an induction
will be successful for you. If your score is 8 or above, it’s a good indication that
spontaneous labor would start soon. If an induction becomes necessary, it’s likely to be
successful.
 If your score is between 6 and 7, then it’s unlikely that labor will be starting soon. An
induction may or may not be successful.
 If your score is 5 or below, it means that labor is even less likely to start spontaneously
soon and an induction is unlikely to be successful

21. BISHOP’S SCORE
 The most common modification to the Bishop score is a simplified scoring system that just
takes into account dilation, effacement, and station (each scored 0 to 3 points). In this shortened
modification, a score of more than 5 is considered favorable.
Contraindications
 Avoid digital cervical exams in a patient with placenta previa or before establishing a diagnosis
of preterm rupture of membranes.

23. NURSING RESPONSIBILITIES
1. Bishop score is considered as a component of antepartum care.
2. The Bishop’s Score does not relate to the length of the labor, or the ease or difficulty of
the labor and delivery of the baby. It only relates to the potential success or failure of a
vaginal delivery outcome.
3.Physician assess the Bishop’s Score from a vaginal examination when the patient is
between 38 and 41 weeks (i.e., at term)
4. Some providers who perform a Bishop’s Score may also add an additional point to the
score if the patient has pre-eclampsia. Providers may also add an addition point for each
previous vaginal delivery.

24. NURSING RESPONSIBILITIES
5.On the other hand, providers may subtract a point if the patient is past her due date
(greater than 40 weeks), has no previous vaginal deliveries, or suffered a pre-term
premature rupture of membranes
6.Doctor calculates your scores through a physical exam and ultrasound. Your cervix can be
examined through a digital exam. The location of your baby's head can be seen on an
ultrasound
7. Documenting the procedure and the findings by the doctor is important.
8. Before everything the nurse should explain the procedure, importance and need for the
procedure to the patient and take consent for it.
9.Check for the contra indications before the procedure.