In the days to weeks before delivery, through a cascade of events, inflammatory mediators increase the production of prostaglandins. Gradually throughout the pregnancy the composition of the cervix changes with decreased collagen density and an increase in hyaluronic acid and water content. The nonpregnant cervix extracellular matrix is primarily made up of tightly packed collagen bundles. While human parturition is not completely understood, it is a complex system that involves interactions between placental, fetal, and maternal mechanisms. Extensive cervical remodeling is needed for the cervix to dilate and pass a fetus fully. The Bishop score reflects the normal changes the cervix undergoes in parturition (the process of childbirth).
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