Bishop Score and the Risk of Cesarean Delivery after Induction of Labor in Nulliparous Women

Abstract

AbstractBackground: Induced labour has an impact on the birth experience of women. It still carries the risk of cesarean delivery compared with spontaneous labour especially for nulliparous women with unfavorable cervix.Objective: To assess the risk and the risk factors for cesarean delivery associated with induction of labor in nulliparous women in relation to bishop score.Design: An interventional study in AL-Khadimia Teaching Hospital.Methods: A group of 198 nulliparous pregnant women with a term singleton fetus in cephalic presentation scheduled for induction participated in this study. Indications and bishop scores were recorded before labor induction. Obstetric and neonatal data were analyzed and compared with the results in women with a low Bishop score. Data were analyzed using univariate and multivariable regression modeling.Results: The cesarean delivery rate in women undergoing labor induction was 46.96%, for Bishop Score ≤4 cesarean section (C/S) rate was 29.79%, and for Bishop Score ≥5 cesarean section (C/S) rate was 14.64%. After adjusting for the Bishop score at admission, Bishop score of 4 or less was a predominant risk factor for a cesarean section (C/S), the degree of cervical dilatation and station of the presenting part was the most significant parameter for risk of cesarean section (C/S). Other variables with significantly increased risk for cesarean delivery included maternal age of 30 years or older and birth weight of 3.500 gm or higher, gestational age of more than 41-42 weeks.Conclusion: Induction of labor in nulliparous women at term with a singleton fetus in cephalic presentation is associated with an increased risk of cesarean delivery predominantly related to an unfavorable Bishop score at admission.Keywords: Induction of labor, Bishop Score, risk of cesarean delivery.