Cervical examination in labour and the Bishop score

5 steps

Dilatation, effacement, station, consistency, position, the presenting part and the membranes, in one careful examination.

Consent and trauma-informed practice

Explain what the examination involves, why it is proposed, and what the alternatives are, in plain language, before anyone undresses.
Ask for permission, and make clear the patient can stop at any point, by saying so or by raising a hand. Stopping is honoured immediately, without persuasion.
Offer a chaperone and record the offer and the response; a student never examines without the supervising clinician present and the patient's specific agreement to the student's involvement.
Privacy: a door that locks or a sign, a sheet, undressing only what is needed, time to undress and dress alone.
Trauma-informed: assume a history you have not been told. Explain each step before it happens, keep talking, avoid sudden touch, ask about pace, and notice dissociation or distress and pause.
Never examine a patient under anaesthesia for teaching without their specific prior consent to that examination.

The sequence

5 steps

01
Cervix
Dilatation in centimetres (the diameter of the os, 10 when it is no longer felt around the head), effacement in percent or length, consistency (firm, medium, soft), position (posterior, mid, anterior).
02
Station
The leading bony point of the presenting part relative to the ischial spines: minus 3 to plus 3 (or minus 5 to plus 5). Caput is not bone.
03
Presenting part and position
Sutures and fontanelles: the sagittal suture's direction and the posterior (small, Y-shaped) versus anterior (large, diamond) fontanelle give occiput anterior, posterior or transverse. Feel for face, brow, breech, cord.
04
Membranes and liquor
Intact (a bulging bag) or ruptured; liquor clear, meconium-stained or bloody.
05
Record
On the partogram, with the time, the findings and the plan.

Assessing labour progress (every 4 hours in active labour, or when a decision depends on it)
Before induction (Bishop score)
After rupture of membranes with a non-reassuring fetal heart rate (cord)

Consent as below; between contractions where possible; sterile gloves; lubricant
Never in a known placenta praevia; a sterile speculum rather than fingers in preterm rupture of membranes without labour

Cord felt: cord prolapse, keep the hand in and call for help
A presenting part that is not a vertex
Loss of station or sudden bleeding in a trial of labour after caesarean: rupture