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Bishop Score for Vaginal Delivery and Induction of Labor

Calculators  Reproductive
The BISHOP Score is used to assess if labor will need to be induced in vaginal delivery. Cervical dilation, cervical length, cervical consistency, cervical position, and station of the presenting part are all factored into the BISHOP Score.
Closed 0
1-2cm 1
3-4cm 2
≥5 cm 3
0-30% 0
40-50% 1
60-0% 2
≥80% 3
-3 0
-2 1
-1,0 2
1,2 3
Posterior 0
Mid-position 1
Anterior 2
Firm 0
Moderately firm 1
Soft 2


Measured Factor
Measured Factor Disease
  • Likelihood for vaginal delivery success
Measured Factor Detail
The BISHOP Score is also termed the cervix score. This score will assist in determining if labor induction will be needed at the time of birth. Labor induction may be done for a variety of reasons. Some of these may include labor after the due date, medical conditions of the mother, or medical conditions of the baby. Labor may be induced by a medication or procedure.
Body System
Measured Factor Low Impact
  • Labor induction is needed for a BISHOP score of less than or equal to 5
Measured Factor High Impact
  • Labor induction not needed
  • N/A

Result Interpretation

Ranges Ranges
  • Critical Low: 6-7 points
  • Critical High: < or equal to 5 points
  • Normal: > or equal to 8 points
  • Normal Adult Male: N/A
  • Normal Adult Female: >5
  • Normal Pediatric: N/A
  • Normal Neonate Female: N/A
  • Normal Geriatric Male: N/A
  • Normal Geriatric Female: N/A
Result Low Conditions
  • Pregnancy complications
  • diabetes
  • hypertension
  • infection
  • Rh blood disease
Result High Conditions
  • N/A
False Positive
  • No dilation
  • low effacement
  • low station of the fetus
  • firm cervix consistency
  • posterior cervix position
References: 2
Test Limitations
References: 2


Study Validation 1
This study compared the clinical utility of the Bishop Score and sonography in predicting cervical ripening and vaginal delivery. 77 nulliparous pregnant women were included in this study at week 41 of gestation. These women had never given birth before and had Bishop Scores less than or equal to 5. This was a prospective study. Prostaglandins were used to ripen the cervix.  63 patients experienced successful cervical ripening. 51 patients experienced vaginal delivery. Sonography was found to be more predictive of cervical ripening and vaginal delivery in this patient population.
References: 3
Study Validation 2
This Bishop Score is used to classify a female’s cervix as ripe or not. Patients considered not ripe are administered prostaglandin. Compared to transvaginal ultrasound, the Bishop Score is more subjective. Using a Bishop Score may result in patients receiving unnecessary prostaglandin. Between November 2008 and August 2010, 154 women were enrolled in the study. 77 women were randomized to receive a Bishop Score. 77 women were randomized to receive a transvaginal ultrasound. 75% of the women whom received a Bishop Score received prostaglandin. 36% of the women whom received a transvaginal ultrasound received prostaglandin.  This was a prospective, randomized study. The use of a transvaginal ultrasound can reduce the need for prostaglandin induction while not adversely affecting the outcome.
References: 4
Study Validation 3
This study aimed to evaluate if the pre-induction cervical assessment and choice of induction agent should be based on a Bishop score or transvaginal ultrasound. Transvaginal ultrasound has been shown to better predict the risk of Cesarean section after induction of labor. Cervical evaluation is used in choosing the induction agent. Between May 2001 and March 2002, 80 women were enrolled upon admission to the University Hospital in Puerto Real in the study. This was a randomized clinical trial. 40 women received a Bishop Score. 40 women received a transvaginal ultrasound. 85% of the women whom received a Bishop Score received prostaglandin. 50% of the women whom received a transvaginal ultrasound received prostaglandin. It still remains controversial if transvaginal ultrasound can replace the Bishop Score or if both should be used together.
References: 5
Study Additional 1
Both the Bishop Score and transvaginal ultrasound can be used to predict cervical ripeness. No studies looked at the usefulness of a transvaginal ultrasound of a mother in the upright position. This study aimed to compare transvaginal ultrasounds both in the supine and upright positions to the Bishop Score. Additionally, the study looked at the effect of the transvaginal ultrasound on mode of delivery. Between February 2004 and September 2006, 102 women were enrolled into the study at a medical center in the Netherlands. Cervical length negatively correlated with the Bishop Score. Cervical length measured by transvaginal ultrasound in an upright position best predicts successful delivery.
References: 6
Study Additional 2
This study aimed to determine risk factors for cesarean delivery in nulliparous women. Bishop Scores were determined prior to labor induction. 1389 women were included in the study at 2 obstetrical centers. This as a prospective cohort study. 12% of women received cesarean delivery with a spontaneous onset of delivery. 23.4% of women received cesarean delivery after labor induction given for medical reasons. 23.8% of women received cesarean delivery after labor induction given for elective reasons. Those with Bishop Scores less than 5 was the predominant risk factor for cesarean delivery. The women who received labor induction had an increased risk for cesarean delivery.
References: 7
Study Additional 3
The Bishop Score remains the most commonly used score to determine cervical ripeness. The aim of this study was to determine if a simplified Bishop Score could be used to predict deliver in nulliparous women with uncomplicated pregnancies. If so, this simplified score could be evaluated for use in other pregnant women. 5610 women were included in the study. Eleven sites from the Consortium on Safe Labor study provided subjects to be enrolled in this study. The Consortium on Safe Labor was conducted between 2002 and 2008. Dilation, station, and effacement were included in the simplified Bishop Score. A simplified Bishop Score greater than 5 was found comparable to an original Bishop Score greater than 8.
References: 8


Edward H. Bishop
MD, Pennsylvania Hospital


  1. Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol. 1964 Aug;24:266-8.
  2. N/A
  3. Kehila M, Bougmiza I, Ben Hmid R, Abdelfatteh W, Mahjoub S, Channoufi MB.Bishop Score vs. ultrasound cervical length in the prediction of cervical ripening success and vaginal delivery in nulliparous women.Minerva Ginecol. 2015 Dec;67(6):499-505.
  4. Park KH, Kim SN, Lee SY, Jeong EH, Jung HJ, Oh KJ. Comparison between sonographic cervical length and Bishop score in preinduction cervical assessment: a randomized trial.Ultrasound Obstet Gynecol. 2011 Aug;38(2):198-204.
  5. Bartha JL1, Romero-Carmona R, Martínez-Del-Fresno P, Comino-Delgado R.Bishop score and transvaginal ultrasound for preinduction cervical assessment: a randomized clinical trial.Ultrasound Obstet Gynecol. 2005 Feb;25(2):155-9.
  6. Meijer-Hoogeveen M1, Roos C, Arabin B, Stoutenbeek P, Visser GH.Transvaginal ultrasound measurement of cervical length in the supine and upright positions versus Bishop score in predicting successful induction of labor at term.Ultrasound Obstet Gynecol. 2009 Feb;33(2):213-20.
  7. Vrouenraets FP1, Roumen FJ, Dehing CJ, van den Akker ES, Aarts MJ, Scheve EJ.Bishop score and risk of cesarean delivery after induction of labor in nulliparous women.Obstet Gynecol. 2005 Apr;105(4):690-7.
  8. Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol. 2011 Apr;117(4):805-11.

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