Families First of Loudoun

Beyond the Bishop Score

Since the 1960′s, the Bishop Score has been a frequently used predictor in assessing feasibility of induction of labor. This scoring system attempts to predict the success of induction by assessing five factors: position of the cervix in relation to the vagina, cervical consistency, dilation, effacement and station of the presenting part. The higher the score, the higher rate of success of the induction. A score less than five indicates an unfavorable cervix for induction. Some texts also reference the Burnett Scale* which assesses approximately the same factors.

In an effort to find a more accurate predictor of successful induction, two relatively new methods are now being used: transvaginal sonography of the cervix and comparative levels of fetal fibronectin.

The length of the cervix can be measured by transvaginal sonography. In expectant mothers with an unfavorable Bishop score (typically less than 7), a cervical length of less than 26 mm is associated with a lower risk of cesarean section and a shorter duration of labor. In several independent studies, when the Bishop score has been as low as 3 and the cervical length was 28 mm, successful induction has been achieved.

To measure the cervical length, an expectant mother goes to an office or radiology department of the hospital. It is an outpatient procedure, where the mother’s bladder is empty and she wears a hospital gown. A transducer (roughly the size of a tampon) is used to transmit ultrasound/ sound waves, which bounce back to produce an image that can be recorded. The transducer is inserted into the vagina and the image is noted on the monitor or it can be printed. This information is reported back to the physician for evaluation.

Fetal fibronectin is a protein that can be found in fetal membranes and amniotic fluid. When present in cervical and vaginal secretions, fetal fibronectin can be useful in determining a woman’s risk for preterm labor and may be predictive in estimating when the mother is ready for labor.

The test for fetal fibronectin is simple and painless, involving only the swabbing of the vaginal and cervical area for a sample of secretions.

It is important to note that expectant mothers showing signs of preterm labor should be tested at 24 to 25 weeks’ gestation, while high-risk women without symptoms can be tested as early as 22 weeks’ gestation and continually tested as appropriate.

Is there, then, a relationship between cervical length, fetal fibronectin and the increase of oxytocin receptor sites on the uterus? We will be anxiously awaiting research on this!

From Birthsource.com

Saying “No” to Induction

When Halloween arrives, I not only think about ghosts and goblins, but I think about when I was pregnant with my second child almost 10 years ago (wow!…has it really been that long?!). His due date was October 31^st, and on Halloween night when my neighbors came by my house to bring their children trick or treating, instead of “trick or treat” I heard, “You haven’t had that baby YET?!” Here I was, very pregnant (you’ll find out why soon) but waiting patiently for my baby to determine when he wanted to be born. I was in no hurry. I knew my body and my baby were doing amazing things in preparation for birth. This leads me into this article that I feel states very important facts about why women may want to become well informed before they decide to have their labor induced. My son was born, when he was ready to be born, exactly a week after Halloween, November 7^th weighing a little over 9 ½ pounds. It was a wonderful birth and one worth waiting for!

Saying “No” to Induction
Judith A. Lothian, PhD, RN, LCCE, FACCE

JUDITH A. LOTHIAN is a childbirth educator in Brooklyn, New York, and a member of the Lamaze International Board of Directors. She is also an associate professor in the College of Nursing at Seton Hall University in South Orange, New Jersey.

Abstract
Induction rates have increased dramatically. A childbirth educator wonders how she can help pregnant women say “no” to induction. This column describes the last days and weeks of pregnancy as vitally important for both the mother and her baby, insuring the baby’s maturity and the mother’s readiness for labor. Women are encouraged to appreciate the last days and weeks of pregnancy and to have confidence that when a woman’s body and her baby are ready, labor will begin spontaneously. This information, as well as knowledge of how induction alters the process of normal labor and birth and increases the possibility of having a near-term infant, is the foundation for informed refusal.

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