Bishopś score or cervix score

      What is a Bishop’s Score and How Does it Relate to Inducing Labor?

      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. 
       Also known as cervix score is a pre-labors. coring system to assist in predicting whether induction of labor will be required.
       ^[1] It has also been used to assess the odds of spontaneous preterm delivery.

      ^[2] The Bishop Score was developed by Dr. Edward Bishop and was published in August 1964.

Bishop’s Score is based on.  

    The total score is achieved by assessing the following five components on vaginal examination:

         1.Cervical dilation
         2.Cervical effacement
         3.Cervical consistency
         4.Cervical position 
         5.Fetal station.    

      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 as a scale   

		Components and their score  shown below

Score				Description
0	1	2	3
Position	Posterior	Middle	Anterior	–	The position of the cervix changes with menstrual cycles and also tends to become more anterior (nearer the opening of the vagina) as labour becomes closer.
Consistency	Firm	Medium	Soft	–	In primigravidwomen the cervix is typically tougher and resistant to stretching, much like a balloon that has not been previously inflated (it feels like the bottom of a chin). With subsequent vaginal deliveries the cervix becomes less rigid and allows for easier dilation at term.
Effacement	0-30%	40-50%	60-70%	80+%	Effacement translates to how 'thin' the cervix is. The cervix is normally approximately three centimetres long, as it prepares for labour and labour continues the cervix will efface till it is 'fully effaced' (paper thin).
Dilation	Closed	1–2 cm	3–4 cm	5+cm	Dilation is a measure of how open the cervical os is (the hole). It is usually the most important indicator of progression through the first stage of labour.
Fetal station	−3	−2	−1, 0	+1, +2	Fetal station describes the position of the fetus' head in relation to the distance from the ischial spines, which are approximately 3-4 centimetres inside the vagina and are not usually felt. Health professionals visualise where these spines are and use them as a reference point. Negative numbers indicate that the head is further inside than the ischial spines and positive numbers show that the head is below the level of the ischial spines.

      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:   

    First time mothers   women with past vaginal deliverie

 scores of  0 – 3:          45%   7.7%

 scores of   4 – 6:         10%    3.9%

 scores of  7 – 10:        1.4%    .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.

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welfare Jambo