A 26-year-old primigravida at 41+2 weeks presents for induction of labour. Cervical examination shows: dilation 1 cm, effacement 40%, station -3, consistency firm, position posterior. Calculate her Bishop score and determine the appropriate cervical ripening method.
- A Bishop score 2 — unfavourable cervix, proceed to mechanical ripening or prostaglandins ✓
- B Bishop score 4 — borderline, direct oxytocin infusion acceptable
- C Bishop score 6 — favourable, proceed directly to amniotomy
- D Bishop score 3 — unfavourable, cervical ripening with prostaglandins or balloon catheter
Correct answer: A. Bishop score 2 — unfavourable cervix, proceed to mechanical ripening or prostaglandins
Explanation
Bishop score components: dilation 1 cm = 1, effacement 40% = 1, station -3 = 0, consistency firm = 0, position posterior = 0 — total = 2. This is an unfavourable cervix (score < 6). Cervical ripening with prostaglandins (misoprostol, dinoprostone) or mechanical methods (Foley catheter balloon) is indicated before oxytocin. Direct oxytocin is appropriate only with a favourable Bishop score ≥ 8. Amniotomy is not appropriate with an undilated unfavourable cervix.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.