In current obstetric practice, induction of labour is often carried out for various maternal and/or fetal reasons

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7.1 SUMMARY

A prospective study at Thapathali's Maternity Hospital over a two and half months' period in the year 1998/99 was performed to study the relationship of Bishop score prior to induction of labour with the outcome of induction by oxytocin infusion and amniotomy in the active stage of labour.

Hundred and three women were included in the study, 48 were in the low BS group and 55 were in the high BS group (study groups). There were 29 nulliparas (60%) and 19 multiparas (40%) in the low BS group (n=48). Similarly, 43 nulliparas (78%) and 12 multiparas (22%) were included in the high BS group (n=55). There were no significant differences in maternal demographic features like age, gestational age, socio-economic status etc. between the two Bishop score categories. All women undergoing induction had a maternal or fetal indication for delivery and the indications did not differ among the two Bishop categories. The rate of induction during the study period was found to be 3.7%. The time required to achieve vaginal delivery after induction (the mean IDI) was greater in women who had low BS than in women with high BS (11.16 hrs Versus 9.02 hrs).
The overall failure of induction was 25% and failure was significantly higher in low BS group than in the high BS group (43.7% Versus 9%).
There was significant difference in the rate of vaginal delivery between the two groups, and the CS rate was also not identical. Caesarean delivery occurred more frequently in the low BS group than in the high BS group (23% Versus 14.5%); and the difference was significant statistically too.
Nulliparas in both the study groups had higher CS rate as compared to multiparas.
The complications of induction of labour were very few in both the groups and not significantly different between the groups except for PPH which was significantly higher in the low BS group (11% Versus 0%). Very few had maternal complications (11.2% in the low BS Versus 12% in the high BS group). Neonatal outcome was satisfactory in the present study with no still birth and early neonatal death in the induced labour and the outcome was not different significantly between the study groups.
The Apgar score at 1 and 5 minute did not differ significantly in both the study groups. The low Apgar score (0-3) at 1 min was found in 3.7% and 4.0% in the low BS and in the high BS groups respectively. Similarly, an Apgar score of 4-6 at 1min was found in 44.4% and 30.0% in the low BS and in the high BS groups respectively. The rest had good Apgar score (7-10). Among the babies, 30% in the low BS group required baby unit admission as compared to 20% in the high BS group. The differences between both the groups were not significant statistically.
More babies in the low BS group needed SCBU admission (30% Versus 20%) and more stayed longer as compared to the high BS group, but these differences were insignificant statistically.

7.2 CONCLUSION

The women with a low Bishop score had a poor outcome of induction of labour in the present study. They had higher failure rate, higher caesarean section rate, longer mean induction delivery interval, higher maternal complications (PPH) and higher special care baby unit admission rate.

APPENDIX - I
OPERATIONAL DEFINITIONS :

1. Failed induction :- It is defined as inability to enter into the active phase of labour despite oxytocin stimulation for a total of 12 hours.
2. Gestational age :- It was calculated from the first day of LMP, or from a dating scan, when available.
3. Bishop scoring system :- The original Bishop scoring system, as shown here, was followed for this study.
NUMERICAL RATING IN THE BISHOP'S SCORING SYSTEM ⁶

Factor	0	1	2	3
Cervical Dilatation	Closed	1-2cm	3-4cm	5cm
Cervical Effacement	0-30%	40-50%	60-70%	80%
Station of head	-3	-2	-1, 0	+1 & +2
Cervical Consistency	firm	medium	soft	-
Cervical Position	posterior	middle	anterior	-

Total Bishop score : 13
Bishop score of 0-4 is generally taken as unfavourable, whereas it is favourable if the score is 5 or more.
A score of 9 or more is taken as imminent labour.

Modified versions of Bishop scores used in various studies are given below.

Modified Bishop score

	0	1	2	3
Dilatation (cms)	less than 1	1-2	2-4	> 4
Length (cms)	more than 4	2-4	1-2	< 1
Consistency	firm	Average	Soft
Position	posterior	mid/anterior	----
Level of head	-3	-2	-1;0	+
		Total Score 12

Fig. 'Cervial score' - a modification of Bishop's score. (Calder et al, 1974)⁹

CERVICAL SCORE

Score	0	1	2
Position of cervix	Posterior	Axial	Anterior
Length of cervix	2 cm	1 cm	< 0.5cm
Dilation of cervix	0 cm	1 cm	> 2 cm
Consistency of cervix	Firm	soft	soft & stretchable
Station of head	-2	-1	0
		Total Score	10

Fig. Cervial score - a modified version of Bishop score (Arulkumaran et al)⁴

APPENDIX - II

QUESTIONNAIRE
GENERAL INFORMATION No : ....................

1. Identification : I.P. No. : ......................... DOA :

1.1 Name :- ................................................................. DOD :

1.2 Age in Yrs. : ...........................................................

1.3 Address : Rural Urban

Permanent

Temporary

1.4 Religion : Hindu Buddhist

Muslim Others

2. Socio-economic status :

2.1 Occupation : Husband Wife

a) Large Scale business/executive

b) Professionals

c) Teacher/Gazetted officer

d) Farmer/Non Gazetted officer

e) Labour/Daily Wage earner

f) Unemployed

2.2 Education :

a) Doctor/Post graduate

b) Graduate

c) Intermediate

d) Secondary School level

e) Primary School/Literate

f) Illiterate

2.3 Appliances :

a) Car b) Motor Bike

c) Bicycle d) None
2.4 Water Supply :

a) Piped b) Tube well/Covered

c) Open well/Pond d) Spring/Well
2.5 Type of latrine :-

a) Flush b) Pour-flush

c) Pit latrine d) Open field
2.6 Type of fuel used :

a) Electricity b) Gas

c) Kerosene d) Wood

e) Combination f) Cow-dung

3. Antenatal History :

3.1 Age at Marriage :

3.2 LMP ........................... EDD ...................... Gestational age ...................

3.3 Gravida ........................ Parity .......................

3.4 ANC None 1-3 Visits >3 Visits
4.1 Indication of induction ..................................................................................

4.2 Pre-induction P/V findings :

a) Cervical : I) Position : b) Station :

II) Consistency : c) Membrane

III) Dilatation : d) Pelvis :

IV) Effacement :

5. Induction of Labour :

5
A.M./P.M.

055/ /
.1 Induction Begin at on

5
A.M./P.M.

055/ /
.2 ARM done at on

5
A.M./P.M.

055/ /
.3 Delivery at on

5
A.M./P.M.

055/ /
.4 Oxytocin stopped at on

5.5 Mode of delivery ND Vacuum

LSCS Forceps
6. Third stage of labour :

a) Blood loss b) Genital tract injury

c) Retained placenta d) Shock
7. Maternal Complication :-

a) Pyrexia b) Death

c) PPH d) Others
8. Fetal outcome :

a) Time of birth : b) Sex : M / F

c) Birth Weight : d) Congenital anomaly

e) Apgar score at 1 min at 5 min

f) Admission to baby unit :-

Yes No

Reason & duration :

NND: Yes No

9. Others ...............................................................................................................

APPENDIX - III

S. No. :

Date :

Consent Form

I am ready to participate in the study. I am providing information correct to my knowledge. I have been explained fully about the study and understood it fully. I am providing this consent voluntarily.

Sign :

Name :
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