Reassessing the Bishop score in clinical practice for induction of labor leading to vaginal delivery and for evaluation of cervix ripening.

Some 60 years ago, obstetrician and clinical researcher Edward H. Bishop first proposed a pelvic score to guide “selection of those patients most suitable for induction” of labor. [1] This original Bishop score is the summation of a numerical estimate for each of five criteria that included cervix dilation, effacement, consistency, position, and station. Notably, only multigravida women at term with prior vaginal delivery were studied, and induction of labor (IOL) methods at the time consisted of oxytocin, membrane stripping, and amniotomy. Empirical evidence by Bishop indicated that “induction may be successfully and safely performed when the pelvic score totals 9 or more. Under such circumstances, we have had no failures in induction, and the average duration of labor has been less than 4 hr” to achieve vaginal birth. IOL has since become more commonplace. Moreover, major advances in management of labor and new approaches to cervical ripening and IOL have improved maternal and newborn outcomes.[2] The simplicity and ease to implement