Understanding the Bishop Score: A Key Tool in Labor Assessment

The Bishop Score, also known as the Cervix Score, remains the gold standard for evaluating cervical readiness for labor induction. Developed by Dr. Edward Bishop in 1964, this scoring system has become foundational in modern obstetrics, providing healthcare providers with a systematic approach to assess labor readiness and guide clinical decision-making.

What is the Bishop Score?

The Bishop Score provides a standardized method for evaluating cervical readiness through vaginal examination. It assesses five critical components, each contributing to a comprehensive evaluation of labor preparedness:

1. Cervical Dilation: The opening of the cervix measured in centimeters
2. Cervical Effacement: The thinning of the cervix expressed as a percentage
3. Fetal Station: The position of the fetal presenting part relative to the ischial spines
4. Cervical Consistency: The firmness or softness of the cervical tissue
5. Cervical Position: The anatomical orientation of the cervix within the birth canal

Clinical Significance

Predicting Labor Onset

The Bishop Score was initially developed to predict spontaneous labor onset:

• Scores ≤ 5: Labor is unlikely to start on its own during the next few days
• Scores 6-8: Requires additional professional consideration and judgment
• Scores ≥ 9: Labor will most likely commence spontaneously in the next few days

Induction Success

A Bishop score of 6 or less often indicates that induction is unlikely to be successful. Some sources indicate that only a score of 8 or greater is reliably predictive of a successful induction.

Understanding the Components

Cervical Dilation

• Scoring:
  • 0 points: Closed
  • 1 point: 1-2 cm
  • 2 points: 3-4 cm
  • 3 points: 5+ cm

Cervical Effacement

• Measured as a percentage of cervical thinning
• Scoring:
  • 0 points: 0-30%
  • 1 point: 40-50%
  • 2 points: 60-70%
  • 3 points: 80+%

Fetal Station

• References the relationship between the presenting part and maternal ischial spines
• Scoring:
  • 0 points: -3
  • 1 point: -2
  • 2 points: -1, 0
  • 3 points: +1, +2

Cervical Consistency

• Assessed through digital examination
• Scoring:
  • 0 points: Firm
  • 1 point: Medium
  • 2 points: Soft

Cervical Position

• Describes cervical orientation relative to vaginal axis
• Scoring:
  • 0 points: Posterior
  • 1 point: Middle
  • 2 points: Anterior

Clinical Applications

Healthcare providers utilize the Bishop Score for:

1. Evaluating readiness for spontaneous labor
2. Determining appropriate timing for induction
3. Assessing the need for cervical ripening
4. Developing individualized labor management plans
5. Counseling patients about delivery options and timing

References

1. Bishop, Edward H. (August 1964). "Pelvic Scoring for Elective Induction." Obstetrics & Gynecology. 24(2): 266-268. [PMID: 14199536]

2. Newman RB, Goldenberg RL, Iams JD, et al. (September 2008). "Preterm Prediction Study: Comparison of the Cervical Score and Bishop Score for Prediction of Spontaneous Preterm Delivery." Obstet Gynecol. 112(3): 508-515. [DOI: 10.1097/AOG.0b013e3181842087] [PMC: 2728002] [PMID: 18757646]

3. "AGOS-Edward H. Bishop." Internet Archive. American Gynecological & Obstetrical Society. [Archived from original on 2015-06-24]

4. Tenore J. (2003). "Methods for cervical ripening and induction of labor." American Family Physician. 67(10): 2123-2128. [PMID: 12776961]

5. "The Bishop score: a tool for induction of labour." Cat.Inist. French Institute for Scientific and Technical Information.

6. Dutta DC. (2001). "Assessment of pelvis and foetus." In: Text Book of Obstetrics. 6th ed. Kolkata: New Central Book Agency. ISBN: 978-81-7381-142-5

Medical Disclaimer

This information is intended for educational purposes only and should not substitute for professional medical advice. Clinical decisions should be made in consultation with qualified healthcare providers, considering individual patient circumstances and current clinical guidelines.