II. Criteria: 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
    2. Cervical Length 2-4 cm (0 to 50% effaced): 1
    3. Cervical Length 1-2 cm (50 to 75% effaced): 2
    4. Cervical Length < 1 cm (>75% effaced): 3
  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
    2. Presenting part at ischial spines -1 cm: 1
    3. Presenting part at ischial spines +1 cm: 2
    4. Presenting part at ischial spines +2 cm: 3

III. Criteria: 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

IV. 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

V. Imaging: Transvaginal Ultrasound (Alternative to Bishop Score)

  1. Cervical Length >28 mm is as effective as Bishop Score to predict need for ripening agents
    1. Park (2011) Obstet Gynecol 38(2): 198-204 [PubMed]

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