Accuracy of visual assessment of the cervix compared to digital examination

Abstract

DIGITAL EXAMINATION LEONARDO PEREIRA, REBECCA GOULD, JACQUELYN PELHAM, Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, PA Drexel University College of Medicine, Department of Obstetrics and Gynecology, Philadelphia, PA OBJECTIVE: To prospectively determine the accuracy of visual assessment of the cervix (VIS) compared to digital cervical examination (DIG). STUDY DESIGN: Prospective study of 100 patients presenting to Labor and Delivery from April to June 2003. Patients requiring both a sterile speculum exam (SSE) andDIG examination were eligible. Exclusion criteria were preterm rupturedmembranes (PPROM) or other contraindication to DIG examination. VIS assessment was made and recorded during SSE. Following SSE, the same physician performed DIG examination. Variables measured included cervical dilation (DIL), effacement (EFF), position (POS), and station of fetal presenting part (STA). A modified Bishop score (BIS) was calculated. Correlation between VIS assessment and DIG examination was measured using Spearman’s correlation coefficient (COR). Type I error was set at 0.05 (twosided). RESULTS:Mean gestational age (GA) at examwas 32.4 weeks (w) (range 1741). 84% of patients had intact membranes; 55% were multiparous. VIS assessment correlated with DIG examination for all parameters measured. This correlation remained significant after controlling for DIL, parity, GA < 34 w, and ruptured membranes (SROM) in term patients with 2 exceptions: EFF in patients < 34 w GA (N = 46, COR .284, P .056), and STA in SROM patients (N = 7, COR .722, P .067). CONCLUSION: Visual assessment correlates with digital examination of the cervix. This correlation remains significant in preterm patients with intact membranes and patients with term SROM and may be applicable to patients with PPROM.