Fetal Presentation (1) ❏ Vertex ❏ Other___________ ❏ If other, physician or certified nurse–midwife notified Estimated fetal weight___________ ❏ Patient has a completed medical history and physical examination ❏ Known allergies identified____________________ ❏ Medical factors that could effect anesthetic choices identified____________________ ❏ Pertinent prenatal laboratory test results (eg, group B streptococci or hematocrit) available (2, 3) ❏ Other special concerns identified (eg, medical problems and special needs):_________________ ❏ Patient counseled about risks and benefits of induction of labor (1) ❏ Consent form signed as required by institution Bishop Score (see below) (1):___________ ❏ Orders received (1) ❏ Oxytocin ❏ Cervical ripening Date______________ Patient ________________________________ Date of birth____________ MR #_____________ Physician or certified nurse–midwife______________________________ Last menstrual period____________________ Gravidity/Parity____________________________ Estimated date of delivery________________ Best estimated gestational age at delivery__________________ Indication for induction _________________ ✓ Patient Safety Checklist INPATIENT INDUCTION OF LABOR Number 2 • November 2011 The American College of Obstetricians and Gynecologists Women’s Health Care Physicians *Station reflects a −3 to +3 scale. Modified from Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol 1964;24:266–8. Bishop Scoring System Factor Dilation Position of Effacement Cervical Score (cm) Cervix (%) Station* Consistency 0 Closed Posterior 0–30 -3 Firm 1 1–2 Midposition 40–50 -2 Medium 2 3–4 Anterior 60–70 -1, 0 Soft 3 5–6 — 80 +1, +2 — Reaffirmed 2014 References 1. Induction of labor. ACOG Practice Bulletin No. 107. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;114:386–97. 2. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Antepartum care. In: Guidelines for perinatal care. 6th ed. Elk Grove Village (IL): AAP; Washington, DC: ACOG; 2007. p. 83–137. 3. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Perinatal infections. In: Guidelines for perinatal care. 6th ed. Elk Grove Village (IL): AAP; Washington, DC: ACOG; 2007. p. 303–48. Standardization of health care processes and reduced variation has been shown to improve outcomes and quality of care. The American College of Obstetricians and Gynecologists has developed a series of patient safety checklists to help facilitate the standardization process. This checklist reflects emerging clinical, scientific, and patient safety advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Although the components of a particular checklist may be adapted to local resources, standardization of checklists within an institution is strongly encouraged. How to Use This Checklist The Patient Safety Checklist on Inpatient Induction of Labor should be completed by the health care provider at the time of the patient’s admission. Copyright November 2011 by the American College of Obstetricians and Gynecologists. 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Requests for authorization to make photocopies should be directed to: Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400. Inpatient induction of labor. Patient Safety Checklist No. 2. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;118:1205–6.

American College of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998