The relationship between the Bishops score at admission and deliver outcomes in nulliparous women in 29 Bahman hospital, Tabriz

Document Type : Original Article


1 Instructor of Midwifery, Department of Midwifery, Tabriz Branch, Islamic Azad University, Tabriz, Iran.

2 M.Sc. in Librarianship, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.


Introduction: The aim of care at birth is having a healthy mother and baby and achieving a successful vaginal delivery. Since unripe cervix leads to increased cesarean rate and causing maternal and neonatal complications, this study was performed with aim to investigate the relationship between Bishop Score at admission and delivery outcomes in nulliparous women.
Methods:This descriptive and analytic study was performed on 300 nulliparous women referring to 29 Bahman Hospital, Tabriz in 2015. Data collection tools included a checklist of individual characteristics, obstetric history, information about Bishop Score at admission, and delivery outcomes. Data were collected through observation of delivery course and studying the contents of the patient’s file. Data was analyzed by SPSS statistical software (version 21) and correlation test. PResults: There was significant relation between Bishop Score and duration of the first and second stage of labor (P=0.0001), duration of uterine contractions in the first stage of labor (P=0.001), abnormal fetal heart rate pattern in the first and second stage of labor (P=0.0001), using oxytocin (P=0.0001), frequency of using oxytocin  (P=0.0001), the distance between the amniotomi or rupture of membranes and delivery (P=0.0001), doing episiotomy (P=0.01), pressure on the  fundus during delivery (P=0.001),  excessive postpartum hemorrhage (P=0.014), first minute Apgar (p=0.014), and measures taken on newborn (P=0.009). Mode of delivery (P=0.0001) was significantly related to Bishop Score at admission, so that 41 cases (31.1%) with Bishop Score ≤4 and 6 (3.6%) with Bishop Score >4 needed to perform cesarean.
Conclusion: Low bishop score and unripe cervix lead to an increase in adverse delivery outcomes and according to the results of this study, proceedings must be done for cervical ripening to promote Bishop score.


  1. Ali J, Hebbar S, Rai L. Alternatives to Bishop score to predict successful induction of labour. Int J Curr Res 2015; 7(1):11632-40.
  2. Delaram M, Rahmani F, Ahmadi A. The reasons for the termination of pregnancies in the third trimester in Shahr-e-kord’s Hadjar hospital during 2005. J Reprod Infertil 2006; 7(1):65-72. (Persian).
  3. Savitz DA, Terry JW Jr, Dole N, Thorp JM Jr, Siega-Riz AM, Herring AH. Comparison of pregnancy dating by last menstrual period, ultrasound scanning and their combination. Am J Obstet Gynecol 2002; 187(6):1660-6.
  4. Nikbakht R, Saharkhiz N, Sayah NP. Comparison of cervical length measurement by transvaginal ultrasonograghy and Bishop score in predicting successful labor induction. Jundishapur Sci Med J 2010; 9(4):385-92. (Persian).
  5. Nadery T, Heydari Z. Correlation between Bishop score and success of induction of labor in term pregnancies. Sci J Hamadan Univ Med Sci 2003; 9(4):18-22. (Persian).
  6. Bastani P, Hamdi K, Abasalizadeh F, Pourmousa P, Ghatrehsamani F. Transvaginal ultrasonography compared with Bishop score for predicting cesarean section after induction of labor. Int J Womens Health 2011; 3:277-80.
  7. Kashanian M, Parashi S, Nikfarjam S. Compare the effectiveness of placing a Foley catheter in the cervical canal and low dose oxytocin infusion method to improve the Bishop score in term pregnancies. Urmia Univ Med Sci 2007; 18(3):562-6. (Persian).
  8. Ghazi Jahani B, Ghotbi R, Ansari S, Aghsi M. A review of Williams pregnancy and childbirth. Tehran: Golban; 2010. P. 318-22. (Persian).
  9. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Cesarean delivery and peripartum hysterectomy. In: William OH, editor. Williams's obstetrics. 22nd ed. New York: McGraw Hill Co; 2005. P. 589-92.
  10. Mohammdpour Asl A, Rostami F, Torabi S. Prevalence of cesarean delivery and demographic factors in Tabriz city, 2004. Med J Tabriz Univ Med Sci Health Ser 2006; 28(3):101-5. (Persian).
  11. Azizi F. Cesarean delivery: shocking increase. Res Med 2007; 31(3):191-3. (Persian).
  12. Heydarnia MA, Rahnama P, Montazeri A, Ebadi M, Rahmati NK. The relationship between early admission in labor and the occurrence of obstetrical complications. Payesh 2008; 7(3):235-9. (Persian).
  13. Alexander JM, MCIntire DD, Leveno KJ. Prolonged pregnancy: induction of labor and cesarean births. Obstet Gynecol 2001; 97(6):911-5.
  14. Cunningham FG, Leveno KJ, Bloom SL, Hautch JC, Gilstrap LC, Wenstrom KD. Williams Obstetrics. 22nd ed. New York: McGraw-Hill; 2010. P. 153.
  15. Engstrom. Maternal-neonatal nursing made incredibly easy. Philadelphia: Lippincott Williams & Wilkins; 2004. P. 315.
  16. Handerson C, Macdonald S. Mayes midwifery a textbook for midwives. 13th ed. London: Baillière Tindall; 2004. P. 864.
  17. Esmaeelzadeh S, Vazirinejad R, Loripour M, Sarafrazi F. Effect of sexual relationship during the last four weeks of pregnancy on Bishop score. Koomesh 2008; 10(1):49-54. (Persian).
  18. Johnson DP, Davis NR, Brown AJ. Risk of cesarean delivery after induction at term in nulliparous women with an unfavorable cervix. Am J Obstet Gynecol 2003; 188(6):1565-9.
  19.  Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol 2011; 117(4):805–11.
  20. Marroquin GA, Tudorica N, Salafia CM, Hecht R, Mikhail M. Induction of labor at 41 weeks of pregnancy among primiparas with an unfavorable Bishop score. Arch Gynecol Obstet 2013; 288(5):989-93.
  21. Preis K, Swiatkowska-Freund M, Pankrac Z. Elastography in the examination of the uterine cervix before labor induction. Ginekol Pol 2010; 81(10):757-61.
  22. Koc O, Duran B, Ozdemirci S, Albayrak M, Koc U. Oxytocin versus sustained‐release dinoprostone vaginal pessary for labor induction of unfavorable cervix with Bishop score ≥ 4 and ≤ 6: a randomized controlled trial. J Obstet Gynaecol Res 2013; 39(4):790-8.
  23. Crane JM. Factors predicting labor induction success: a critical analysis. Clin Obstet Gynecol 2006; 49(3):573-84.
  24. Teixeira C, Lunet N, Rodrigues T, Barros H. The Bishop score as a determinant of labour induction success: a systematic review and meta-analysis. Arch Gynecol Obstet 2012; 286(3):739-53.
  25. Kolkman DG, Verhoeven CJ, Brinkhorst SJ, van der Post JA, Pajkrt E, Opmeer BC, et al. The Bishop score as a predictor of labor induction success: a systematic review. Am J Perinatol 2013; 30(8):625-30.
  26. Uyar Y, Erbay G, Demir BC, Baytur Y. Comparison of the Bishop score, body mass index and transvaginal cervical length in predicting the success of labor induction. Arch Gynecol Obstet 2009; 280(3):357-62.
  27. Ryu A, Park K, Lee S, Kim S, Oh K, Kim A. P18. 01: Maternal weight, Bishop score, and sonographically measured cervical length at 37 weeks' gestation for predicting the risk of intrapartum Cesarean delivery in parous women. Ultrasound Obstet Gynecol 2012; 40(S1):240.
  28. Motamed N. Bishop score in determining the predictive value of full term successfully induced labor in women Persian Gulf Martyrs' Hospital, 2012-13. [Doctoral Dissertation]. Bushehr University of Medical Sciences, Bushehr, Iran; 2014. (Persian).
  29. Bailit JL, Die rker L, Blanchard MH, Mercer BM. Outcomes of women presenting in active versus latent phase of spontaneous labor. Obstet Gynecol 2005; 105(1):77-9.
  30. Raghuraman N, Stout MJ, Young OM, Tuuli MG, Lopez J, Macones GA, et al. 496: Admission modified Bishop score for women in spontaneous labor: useful or useless? Am J Obstet Gynecol 2016; 214(1):S271
  31. Ajori L, Masoumi M, Rahbari H, Ahmadi K. Prolonged Latent Phase: Maternal and Neonatal Outcomes. J Shahid Sadoughi Univ Med Sci 2010; 18(1):3-7. (Persian).
  32. Sehati Shafaee F, Naghizadeh S, Ghujazadeh M. Comparing the length of laboring in women who admitted in latent and active phase of labor in Taleqani hospital of Tabriz. Iran J Obstet Gynecol Inferril 2012; 15(20):19-27. (Persian).
  33. Holmes P, Oppenheimer LW, Wen SW. The relationship between cervical dilatation at initial presentation in labour and subsequent intervention. BJOG 2001; 108(11):1120-4.