Role of the Bishop Score in Predicting Successful Induction of Vaginal Delivery: A Systematic Review of Current Evidence.

Labor induction is a common obstetric intervention, and the Bishop score remains a widely used clinical tool for predicting its success by assessing cervical readiness. This systematic review synthesizes evidence from 36 studies published between 2013 and 2025 across diverse populations to evaluate the predictive value of the Bishop score for successful vaginal delivery following labor induction. The analysis highlights that a Bishop score below 6 typically necessitates cervical ripening with pharmacologic and mechanical methods demonstrating variable efficacy based on initial cervical conditions. Prostaglandins, particularly dinoprostone and misoprostol, show superior effectiveness in women with unfavorable scores (≤3-4), while simpler interventions suffice when scores are ≥6. The integration of additional predictors, including ultrasound-based parameters (cervical length, uterocervical angle) and biochemical markers (fetal fibronectin, IGFBP-1), has demonstrated improved prognostic accuracy. Machine learning models combining clinical and sonographic data further enhance prediction and guide individualized induction strategies. Despite the Bishop score's continued clinical relevance, limitations in its predictive capacity, particularly in heterogeneous populations, highlight the need for refined, multiparametric tools. In the context of vaginal birth after cesarean (VBAC), Bishop score contributes to risk stratification and induction planning, but its predictive value must be contextualized within broader clinical factors. Overall, the Bishop score remains a valuable component of labor management; however, the evolving landscape of obstetric care calls for its integration with modern technologies and evidence-based adjuncts to optimize induction outcomes and ensure patient-centered decision-making.