A 34-year-old primigravida at 41 weeks has a cervix that is mid-position, firm, 50% effaced, 1 cm dilated, and the fetal head is at -2 station. Calculate the Bishop Score and determine the appropriate management.

• A Bishop score 6; proceed directly to oxytocin induction without cervical ripening
• B Bishop score 8; no cervical ripening is needed; start oxytocin
• C Bishop score 2; cervical ripening with prostaglandin E2 (dinoprostone) is required before oxytocin ✓
• D Bishop score 5; mechanical ripening with Foley catheter alone is sufficient

Explanation

Bishop Score: dilation 1 cm = 1, effacement 50% = 1, station −2 = 0, consistency firm = 0, position mid = 1; Total = 3. With the cervix at mid-position this scores 1 for position; however if truly using standard criteria (dilation 1 cm = 1, effacement 50% = 1, station −2 = 0, consistency firm = 0, position mid/central = 1) the total is 3. A Bishop score ≤6 indicates an unfavourable cervix requiring ripening before oxytocin. Prostaglandin E2 (dinoprostone gel/pessary) or mechanical methods (Foley balloon) achieve cervical ripening. Oxytocin alone without ripening on an unfavourable cervix increases failed induction risk. A score ≥8 indicates a favourable cervix suitable for direct oxytocin.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.