MCQs on Bishop Score
1. Which of the following parameters is NOT a component of the Bishop score?
A) Cervical dilation
B) Fetal station
C) Uterine contraction frequency
D) Cervical consistency
Rationale:
The Bishop score strictly evaluates the physical readiness of the cervix and fetal descent, not uterine muscle activity or contraction patterns.
The five specific components are
- Dilation
- Effacement
- Station
- Cervical consistency
- Ccervical position.
2. A primigravida is scheduled for labor induction. Her Bishop score is calculated to be 4. What is the most appropriate clinical interpretation and anticipated next step?
A) The cervix is favorable; initiate oxytocin infusion immediately.
B) The cervix is unfavorable; administer a cervical ripening agent.
C) The cervix is highly favorable; prepare for an emergency cesarean section.
D) The cervix is fully dilated; encourage the mother to start pushing.
Rationale:
- A Bishop score of 5 or less indicates an unfavorable or “unripe” cervix.
- Initiating an oxytocin infusion on an unripe cervix significantly increases the risk of prolonged labor and failed induction.
- Cervical ripening (using pharmacological or mechanical methods) is the standard prerequisite intervention when the score is unfavorable.
3. During a vaginal examination, the nursing officer notes that the fetal head is exactly at the level of the maternal ischial spines. What score is assigned for fetal station in the Bishop scoring system?
A) 0 points
B) 1 point
C) 2 points
D) 3 points
Rationale:
Fetal station at the level of the ischial spines is clinically documented as “0 station”.
In the Bishop scoring system, a fetal station of -1 or 0 is awarded exactly 2 points.
- A high station of -3 receives 0 points,
- -2 receives 1 point,
- a descended station of +1 or +2 receives 3 points.
4. What is the maximum possible total score a patient can achieve on the Bishop scoring system?
A) 10
B) 11
C) 13
D) 15
Rationale:
- Dilation, effacement, and fetal station are each scored from 0 to 3 (yielding a maximum of 9 points).
- Cervical consistency and cervical position are each scored from 0 to 2 (yielding a maximum of 4 points).
- Adding the maximum points for all five categories yields a total maximum score of 13.
5. When calculating a Bishop score, which clinical finding would earn the maximum score of 3 points for cervical effacement?
A) 0% to 30% effacement
B) 40% to 50% effacement
C) 60% to 70% effacement
D) 80% or greater effacement
Rationale:
Effacement evaluates how thin and shortened the cervix has become in preparation for delivery.
- 0–30% effacement receives 0 points
- 40–50% receives 1 point
- 60–70% receives 2 points.
Maximum effacement (more than/equal to 80%) demonstrates advanced cervical readiness, leaving the cervix paper-thin, and is awarded the maximum 3 points.
6. A nursing officer is reviewing a patient’s Bishop score components. The cervix is palpated as “firm,” similar to the texture of the tip of a nose. How many points should be documented for cervical consistency?
A) 0 points
B) 1 point
C) 2 points
D) 3 points
Rationale:
A firm cervix indicates it has not yet undergone the physiological softening (collagen breakdown) required for labor, thus it receives 0 points.
A medium consistency receives 1 point, and a soft cervix (pliable, similar to the lips) receives the maximum 2 points.
Consistency is only scored up to 2 points, making option D structurally impossible in this scale.
7. A Bishop score of 9 is recorded in a patient’s chart at 39 weeks of gestation. How should the nursing officer interpret this finding?
A) The patient requires immediate administration of prostaglandins.
B) The patient has an unfavorable cervix and will likely require a cesarean delivery.
C) The cervix is favorable, and a successful vaginal delivery after induction is highly likely.
D) The fetus is experiencing severe distress and hypoxia.
Rationale:
A Bishop score of 8 or higher is universally classified as a “ripe” or highly favorable cervix.
This score correlates strongly with a high probability of successful vaginal delivery, statistically equivalent to spontaneous natural labor.
Prostaglandins are unnecessary and potentially contraindicated when the cervix is already highly favorable, as they risk causing uterine hyperstimulation.
8. Which component of the Bishop score specifically evaluates the alignment of the cervical os relative to the maternal birth canal?
A) Fetal station
B) Cervical effacement
C) Cervical position
D) Cervical consistency
Rationale:
Cervical position tracks the physiological migration of the cervix from a posterior position (pointing backward towards the sacrum) to an anterior position (aligned squarely with the vagina) as labor approaches.
- A posterior position gets 0 points
- a midposition gets 1 point
- a fully anterior position receives the maximum 2 points.
9. Before performing a digital cervical examination to calculate a Bishop score, what is the most critical contraindication the nurse must rule out?
A) Gestational diabetes
B) Placenta previa
C) Mild preeclampsia
D) Previous history of normal vaginal delivery
Rationale:
- Placenta previa (where the placenta covers the cervical os) is an absolute contraindication for digital cervical examinations.
Inserting fingers into the cervical canal can puncture or detach the placenta, leading to catastrophic, life-threatening maternal hemorrhage and fetal compromise.
Bishop scoring must be deferred or evaluated via transvaginal ultrasound if previa is suspected.
10. In the Simplified Bishop Score used in some contemporary clinical practices, which two parameters are often omitted because they are highly subjective and less independently predictive of induction success?
A) Cervical dilation and fetal station
B) Cervical position and cervical consistency
C) Fetal station and cervical effacement
D) Cervical dilation and cervical effacement
Rationale:
Research has demonstrated that cervical position and consistency are highly subjective between different examiners and carry less predictive weight for induction success.
The simplified Bishop score focuses entirely on the objective, highly predictive triad of dilation, effacement, and fetal station.