Jillian Mendoza III-BN Bishop's score, is a pre-labour scoring system to assist in predicting whether induction of labour will be required.

It has also been used to assess the odds of spontaneous preterm delivery. 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 Scoring Each component is given a score of 0-2 or 0-3. The highest possible score is 13. Bishop score

Parameter\Score

Description

Position

Posterior Intermediate Anterior -

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

Consistency

Firm

Intermediate Soft

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.

Effacement

0-30%

31-50%

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, 51-80% >80% it becomes thinner. This is affected by individual variation and previous surgery such as loop excision for cervical dysplasia or cancer.

Dilation

0 cm

1 2 cm

Dilation is a measure of the diameter of the stretched cervix. It complements 3 4 cm >5 cm effacement, and is usually the most important indicator of progression through the first stage of labour.

Fetal station

-3

-2

-1, 0

Fetal station describes the position in of the foetus' head in relation to the distance from the ischial spines, which can be palpated deep inside the +1, +2 posterior vagina (approximately 8 10 cm) as a bony protrusion. Negative numbers indicate that the head is further inside, above the ischial spines.

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.

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)

Jillian Mendoza III-BN Bishop Score A Bishop's Score refers to a group of measurements used to determine whether a woman may have a successful vaginal delivery and whether labor ought to be induced. Bishop's Score is based on station, dilation, effacement, position and consistency. Station is a term used to describe the descent of the baby into the pelvis. An imaginary line is drawn between the two bones in the pelvis (known as ischial spines). This is the "zero" line, and when the baby reaches this line it is considered to be in "zero station." When the baby is above this imaginary line it is in a minus station. When the baby is below, it is in a "plus" station. Stations are measured from -5 at the pelvic inlet to +4 at the pelvic outlet. Dilation is measured in centimeters, from 0 to 10. Your cervix is fully open and you should be able to push when it is dilated to 10 centimeters. Occasionally, a physician will measure dilation in "fingers." Dilation often begins days or weeks before labor actually begins. At first, the progress may be very slow. Some women may be dilated 2 to 3 centimeters long before labor. Once active labor begins, you will begin to dilate more quickly. Effacement refers to the softening and thinning of the cervix. You won't feel this happening; it may only be measure with a vaginal exam. Effacement is measured in percent. When your cervix is normal, it is considered to be 0% effaced. When you're 50% effaced, your cervix is half its original thickness. When your cervix is 100% effaced it is completely thinned out and you are ready for vaginal delivery. Position refers to the positioning of the cervix. If the cervix faces front (anterior) it is more favorable, while posterior is less favorable. Consistency of the cervix is measured on a scale of firmness from firm to soft. The softer the cervix is, the better the chance of vaginal delivery. The Bishops Score generally follows this scale: Score 0 1 2 3 Dilatation closed 1-2 cm 3-4 cm 5+ cm Effacement Station Position Consistency

0 30% 40 -50% 60 -70% 80+%

-3 posterior firm -2 mid-position moderately firm -1,0 anterior soft +1,+2

A point is added to the score for each of the following: Preeclampsia Each prior vaginal delivery A point is subtracted from the score for: Postdates pregnancy Nulliparity Premature or prolonged rupture of membranes Interpretation cesarean rates: scores of 0 3: scores of 4 - 6: scores of 7 - 10: first time mothers 45% 10% 1.4% women with past vaginal deliveries 7.7% 3.9% .9%

Induction is generally attempted when a mother has a favorable Bishop's score. A mother may be given misoprostol, cytotec or prostaglandin gel to help ripen the cervix and improve the score. A score of five or less is said to be "unfavorable." If induction is indicated, the mother would be a candidate for a cervical ripening agent. These are usually introduced one or two nights before the planned induction. A score of eight or nine would indicate that the cervix was very ripe and induction would have a high probability of being successful.