Background Nulliparous women undergoing induction of labour (IOL) have a high risk of caesarean section. To date, cervical assessment is the only clinical parameter that is used to assess this risk.

Aim To develop a clinical tool that could be used to assess risk of caesarean section in women having IOL.

Methods 605 women in Group A with IOL at term (April 2009 - March 2010) and 402 women in Group B undergoing IOL for post-dates (April 2010 – March 2011) were included. ROC curve analysis using group A identified Bishop score ≤ 3 and pre-induction base-line fetal heart rate ≥ 141 bpm as being predictive of caesarean section. A composite score was developed with Bishop score (≤ 3= 1, >3 = 0) and baseline fetal heart rate (≥ 141= 1, < 141 = 0).

Results Nulliparous with post-dates induction (Group A, n = 152) had 28.8%, 38.5% and 70% risk for caesarean section for composite scores 0, 1 and 2 respectively (p = 0.001). The risk of caesarean section in nulliparous women in group B was 23.1%, 36.7% and 48.2% for scores 0, 1 and 2 respectively (p < 0.05). The scoring system was not discriminatory in multiparous women or other term IOL.

Conclusion A composite scoring system identified nulliparous post-dates women with a low, moderate and high risk of caesarean section. However, the system is not sufficiently discriminatory for clinical use.