Shokhan F. Ahmed a, and Sallama K. Nasir b

KBMS Trainee,Sulaimani Maternity Teaching Hospital, Ministry of Health, Kurdistan Region, Iraq.

b Dept. of Obstetrics and Gynecology, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.


Submitted: 6/6/2020; Accepted: 19/5/2021; Published: 21/6/2021

DOI Link: https://doi.org/10.17656/jsmc.10306 



Induction of labor (IOL) refers to the stimulation or artificially initiating uterine contractions before its spontaneous onset, to effect progressive effacement and dilatation of the cervix and, ultimately, delivery of a baby. The Bishop’s Score also known as the cervical score is a pre-labor scoring system to assist in predicting the success of labor induction.


To assess the outcome of induction of labor (whether vaginal delivery or Cesarean Section) concerning Bishop Score. 

Patients and Methods

This is a prospective cohort study, conducted at Sulaimani maternity teaching hospital for 10months startingfrom 1st April 2019 till 30th of January 2020. The study included 152 pregnant nulliparous women with singleton viable fetus, cephalic presentation, and intact membranes with no medical disease who were admitted to hospital for induction of labor because of postdate pregnancy (gestational age> 40 weeks). The studied women were divided into two groups according to their Bishop Score on admission. Group (1) are women with Bishop Score < 6 who underwent Labour induction with 25 microgram misoprostol followed by oxytocin drip. Group (2) are womenwhose Bishop Score ≥ 6 underwent induction of labor by oxytocin drip. Women in both groups were followed up throughout induction till delivery and the outcome of labor was compared between the two groups.


There was statistically significant association between the bishop score at time of induction and mode of delivery since (40.4%) of women in group (1) delivered by C/S and (59.6%) delivered vaginally, while the majority (80.9%) of women in group (2) had successful induction of labor and delivered vaginally and only 19.1% delivered by C/S, (P value = 0.005). The main cause of C/S in group(1)was failure of progress in first stage of labor (38.8%), followed by meconium stained liquor (27.7%) and fetal distress (25.2%). While for group (2), the main cause of C/S was meconium stained liquor (50.0%), followed by fetal distress (33.4%) .The difference was statistically highly significant (p-value =0.01) also the duration of labor was significantly related to bishop score, women with bishop score < 6 has longer duration of labor compared to women with bishop score ≥ 6 in spite of using misoprostol as a ripening agent (p- value=0.05).


Assessment of bishop score at the time of induction of labor can predict the outcome of induction. Nulliparous woman with a low bishop score (<6) at the time of IOL is at risk of failure of induction and delivery by C/S despite using cervical ripening agents.


Bishop Score, Having Cesarean Delivery, Nulliparous women.


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