768: The correlation between the number of vaginal examinations during active labor and peripartum complications

Abstract

We aimed to study the effect of each vaginal examination (VE) performed in active labor (AL) on maternal febrile morbidity and perineal trauma. All women who underwent a trial of labor >24 gestational weeks, in a single tertiary medical center, between 2008- 2017 were included. For each delivery, the number of VEs performed in the first and second stages of AL was retracted from the computerized database. For the purpose of this study, AL was defined as cervical dilatation >4 cm, associated with regular uterine contractions, with or without rupture of the membranes. Data regarding the length of each stage of AL, mode of delivery, and peripartum complications were retracted. Peripartum complications included: intrapartum febrile morbidity (intrapartum fever ≥ 380C and/or culture-proven chorioamnionitis), postpartum febrile morbidity (postpartum fever ≥ 380C, and/or culture-proven endometritis, and/or surgical site infection), and perineal trauma (perineal tears grade 1-4 and/or cervical tears). Overall, 33,292 women were included in the study. The number of VEs performed in the first and second stages of AL and the associated complications in univariate analysis are presented in the table. On multivariate analysis, after controlling for confounders including the length of each stage of AL, we found that each additional VE during the first stage of AL increased the risk of any febrile morbidity by 1.5% (aOR 1.015, 95% CI 1.005-1.03). Each additional VE during the second stage of AL increased the risk of perineal trauma by 10% (aOR 1.10, 95% CI 1.08- 1.12), and the risk of postpartum febrile morbidity by 11% (aOR 1.11, 95% CI 1.06-1.16). The number of VEs during the first stage directly correlated with the risk for postpartum febrile morbidity and any febrile morbidity (p<0.001 for both). The number of VEs during the second stage of AL directly correlated with the risk of perineal trauma, postpartum febrile morbidity, and any febrile morbidity (p<0.001 for all) (figure). The number of VEs performed in AL directly correlates with febrile morbidity and perineal trauma. These data should be taken into consideration by obstetricians in decision making regarding the number of VEs to perform in each stage of AL.View Large Image Figure ViewerDownload Hi-res image Download (PPT)