Vaginal Examinations In Labour Research Articles

A challenging climate: authoritative speech and saying no to routine vaginal examination in labour

A challenging climate: authoritative speech and saying no to routine vaginal examination in labour

Fetal malposition in labour and health outcomes for women and their newborn infants: A retrospective cohort study.

Occiput-posterior (OP) or occiput-transverse (OT) fetal malposition has a prevalence of 33-58% in the first-stage of labour with 12-22% persisting until delivery. Malposition is associated with significant maternal and neonatal morbidity. Most previous studies report the incidence and adverse maternal and fetal outcomes of persistent fetal malposition in the second stage of labour and do not include outcomes that may be present in the first stage of labour. To assess the incidence and health outcomes for women and their newborn infants of a fetal malposition in the first or second stage of labour. A retrospective cohort study of 738 maternity records (randomly selected) from a tertiary hospital in New Zealand. Maternal and neonatal characteristics are described. Outcomes for women with a fetus in an OP or OT position in labour are compared to those for women with a fetus in an occiput-anterior position (OA). 499 (68%) women had an OP/OT positioned fetus and 239 (32%) had an OA positioned fetus on vaginal examination in labour. Women had similar characteristics except a body mass index ≥30 kg/m2 was more common in the OP/OT group. Fetal malposition appears to be more likely in women with a right-sided fetal occiput. Three quarters of OP/OT fetuses rotated anteriorly by birth. Fetal malposition compared to no malposition was associated with oxytocin augmentation, epidural use, a longer first stage of labour, fewer normal vaginal births, and more caesarean sections. Fetal malposition during labour was not associated with adverse neonatal outcomes. Interventions such as maternal posture in the first and second stage of labour could potentially reduce the incidence of malposition and improve health outcomes for mothers.

Women’s Experiences and Frequency of Vaginal Examination during Labor

Objective: Vaginal examinations (VE’s) are techniques that are widely used by midwives, nurses or doctors to assess the progress of labor. The present study aimed to determine the women’s experiences and frequency of VE during labor.
 Methods: A total of 328 women who gave vaginal birth were included in this descriptive study conducted in Turkey between January and October 2019. Data were collected in the first 24 h after birth using the “The Women's Experiences of Vaginal Examinations in Labour (WEVEL)” Scale. 
 Results: VE was performed 4.05±1.721 (range,1–12) times and by 2.41±1.241 (range,1–7) different medical personnel during labor. During VE, women mostly experience fear, pain, and shame. The average score of women on the WEVEL scale was 74.18±10.078 (good level). VE experiences of women to whom information was provided before the procedure, for whom the sex of medical personnel did not matter, whose privacy was protected, and on whom VE was performed by the same medical personnel were more positive; the difference was statistically significant (p

Panamanian women׳s experience of vaginal examination in labour: A questionnaire validation

Aimto validate a tool that allows healthcare providers to obtain accurate information regarding Panamanian women׳s thoughts and feelings about vaginal examination during labour that can be used in other Latin-American countries. Methodsvalidation study based on a database from a cross-sectional study carried out in two tertiary care hospitals in Panama City, Panama. Women in the immediate postpartum period who had spontaneous labour onset and uncomplicated deliveries were included in the study from April to August 2008. Researchers used a survey designed by Lewin et al. that included 20 questions related to a patient׳s experience during a vaginal examination. Findingsfive constructs (factors) related to a patient׳s experience of vaginal examination during labour were identified: Approval (Alpha Cronbach׳s 0.72), Perception (0.67), Rejection (0.40), Consent (0.51), and Stress (0.20). Conclusionit was demonstrated the validity of the scale and its constructs used to obtain information related to vaginal examination during labour, including patients’ experiences with examination and healthcare staff performance. Implications for practiceutilisation of the scale will allow institutions to identify items that need improvement and address these areas in order to promote the best care for patients in labour.

Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term

Vaginal examinations have become a routine intervention in labour as a means of assessing labour progress. Used at regular intervals, either alone or as a component of the partogram (a pre-printed form providing a pictorial overview of the progress of labour), the aim is to assess if labour is progressing physiologically, and to provide an early warning of slow progress. Abnormally slow progress can be a sign of labour dystocia, which is associated with maternal and fetal morbidity and mortality, particularly in low-income countries where appropriate interventions cannot easily be accessed. However, over-diagnosis of dystocia can lead to iatrogenic morbidity from unnecessary intervention (e.g. operative vaginal birth or caesarean section). It is, therefore, important to establish whether or not the routine use of vaginal examinations is an effective intervention, both as a diagnostic tool for true labour dystocia, and as an accurate measure of physiological labour progress.To compare the effectiveness, acceptability and consequences of digital vaginal examination(s) (alone or within the context of the partogram) with other strategies, or different timings, to assess progress during labour at term.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2013) and reference lists of identified studies.We included randomised controlled trials (RCTs) of vaginal examinations (including digital assessment of the consistency of the cervix, and the degree of dilation and position of the opening of the uterus (cervical os); and position and station of the fetal presenting part, with or without abdominal palpation) compared with other ways of assessing progress of labour. We also included studies assessing different timings of vaginal examinations. We excluded quasi-RCTs and cross-over trials. We also excluded trials with a primary focus on assessing progress of labour using the partogram (of which vaginal examinations is one component) as this is covered by another Cochrane review. However, studies where vaginal examinations were used within the context of the partogram were included if the studies were randomised according to the vaginal examination component.Three review authors assessed the studies for inclusion in the review. Two authors undertook independent data extraction and assessed the risk of bias of each included study. A third review author also checked data extraction and risk of bias. Data entry was checked.We found two studies that met our inclusion criteria but they were of unclear quality. One study, involving 307 women, compared vaginal examinations with rectal examinations, and the other study, involving 150 women, compared two-hourly with four-hourly vaginal examinations. Both studies were of unclear quality in terms of risk of selection bias, and the study comparing the timing of the vaginal examinations excluded 27% (two hourly) to 28% (four hourly) of women after randomisation because they no longer met the inclusion criteria.When comparing routine vaginal examinations with routine rectal examinations to assess the progress of labour, we identified no difference in neonatal infections requiring antibiotics (risk ratio (RR) 0.33, 95% confidence interval (CI) 0.01 to 8.07, one study, 307 infants). There were no data on the other primary outcomes of length of labour, maternal infections requiring antibiotics and women's overall views of labour. The study did show that significantly fewer women reported that vaginal examination was very uncomfortable compared with rectal examinations (RR 0.42, 95% CI 0.25 to 0.70, one study, 303 women). We identified no difference in the secondary outcomes of augmentation, caesarean section, spontaneous vaginal birth, operative vaginal birth, perinatal mortality and admission to neonatal intensive care.Comparing two-hourly vaginal examinations with four-hourly vaginal examinations in labour, we found no difference in length of labour (mean difference in minutes (MD) -6.00, 95% CI -88.70 to 76.70, one study, 109 women). There were no data on the other primary outcomes of maternal or neonatal infections requiring antibiotics, and women's overall views of labour. We identified no difference in the secondary outcomes of augmentation, epidural for pain relief, caesarean section, spontaneous vaginal birth and operative vaginal birth.On the basis of women's preferences, vaginal examination seems to be preferred to rectal examination. For all other outcomes, we found no evidence to support or reject the use of routine vaginal examinations in labour to improve outcomes for women and babies. The two studies included in the review were both small, and carried out in high-income countries in the 1990s. It is surprising that there is such a widespread use of this intervention without good evidence of effectiveness, particularly considering the sensitivity of the procedure for the women receiving it, and the potential for adverse consequences in some settings.The effectiveness of the use and timing of routine vaginal examinations in labour, and other ways of assessing progress in labour, including maternal behavioural cues, should be the focus of new research as a matter of urgency. Women's views of ways of assessing labour progress should be given high priority in any future research in this area.

Improving Vaginal Examinations Performed by Midwives = تحسين مهارة الفحص المهبلي للقابلات

A vaginal examination (VE) is an essential part of midwifery care, and is routinely performed when assessing the progress of labour. As evidence shows that during labour women may find VEs unpleasant, embarrassing and sometimes painful, the aim of this article is to review literature on the use of VEs during labour and to synthesise information from the available literature on how to provide an effective VE. The studies considered were retrieved from three databases (the Cumulative Index to Nursing and Allied Health Literature [CINAHL], SCOPUS and MEDLINE) using the following search terms: "VEs in labour", "midwives and use of VEs" and "women experiences of VEs in labour". The literature reviewed suggests that midwives are not careful about VEs. Therefore, a concerted effort is needed to pay attention to the frequency of VEs, the management of pain and distress, information-giving and the preferences of the patient, so that the patient can feel in control during a VE.

746: Does the neonatal impact of chorioamnionitis in the setting of PPROM vary depending on degree of prematurity?

setting of PPROM vary depending on degree of prematurity? Shireen de Sam Lazaro, Yvonne Cheng, Jonathan Snowden, Leonardo Pereira, Natali Aziz, Aaron Caughey Oregon Health and Science University, Obstetrics and Gynecology, Portland, OR, University of California-San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, Stanford, Obstetrics and Gynecology, Palo Alto, CA OBJECTIVE: To examine if neonatal outcomes vary based on the diagnosis of chorioamnionitis in the setting of pregnancies complicated by preterm premature rupture of membranes, (PPROM) and whether this difference varies by gestational age. STUDY DESIGN: A retrospective cohort study was conducted of all pregnancies complicated by PPROM who delivered between 24 to 36 weeks and 6 days gestation in 2006 in California (n 5229). Pregnancies were grouped by gestational age, and patients who delivered with a diagnosis of chorioamnionitis were compared to patients without this diagnosis. Neonatal outcomes were assessed including necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and sepsis. Dichotomous outcomes were compared using Fisher’s exact test, with P 0.05 indicating statistical significance. RESULTS: 5,229 women were diagnosed with PPROM between 24 weeks to 36 weeks 6 days, and 306 (5.9 %) women were diagnosed with chorioamnionitis prior to delivery during the study period. Neonates born to mothers diagnosed with chorioamnionitis were noted to have significantly higher rates of sepsis across each gestational age (Table). Additionally, amongst the most premature infants, an association between chorioamnionitis and IVH was noted, though this did not reach statistical significance. Chorioamnionitis was not noted to affect the rate of necrotizing enterocolitis across the gestational ages. CONCLUSION: Patients who develop chorioamnionitis in the setting of PPROM are at an increased risk of neonatal sepsis. Additionally, the most premature infants delivered in the setting of chorioamnionitis may be an increased risk of intraventricular hemorrhage. No increased risk for necrotizing enterocolitis was noted amongst neonates delivered with chorioamnionitis compared to those without that diagnosis across all gestational ages. 747 Clinical significance of elevated high-sensitivity C-reactive protein in amniotic fluid obtained at emergency caesarean section Zbigniew Marchocki, Maurice O’Donoghue, Kevin Collins, Keelin O’Donoghue Cork University Maternity Hospital, University College Cork, Obstetrics & Gynaecology, Cork, Ireland, Cork University Maternity Hospital, University College Cork, Microbiology, Cork, Ireland OBJECTIVE: Delivery by caesarean section (CS) is the single most important factor associated with post-partum infection. Risk factors include obesity, prolonged operating time, poor surgical technique and emergency delivery. While the majority of infections are not life threatening they have implications on length of hospital stay, costs and re-admission rates. We examined high-sensitivity C-reactive protein (HS-CRP) levels in amniotic fluid (AF) and maternal serum at the time of CS and correlated results with risk factors for infection and postpartum infectious complications. STUDY DESIGN: This was a prospective observational study of women undergoing elective and emergency CS. AF for HS-CRP analysis was obtained at CS by direct needle aspiration from the intact amnion. Maternal serum HS-CRP was measured before and 3 days after CS. Results were correlated with maternal and neonatal outcomes. RESULTS: Seventy-four women had AF samples collected at CS; of these 53% (39/74) underwent emergency CS. There was a significant difference in HS-CRP in AF at emergency CS, with levels on average 10 fold higher (p 0.009). No difference in AF HS-CRP levels was noted in women with BMI 25 or between smokers. In the emergency CS group, AF HS-CRP levels were not affected by length of labour, fetal blood sampling or pyrexia in labour. However there was a significant difference in AF HS-CRP levels in women who had multiple ( 7) vaginal examinations in labour (p 0.003). Overall, 11% of women developed post-partum infectious complications, but there was no difference in AF HS-CRP levels. Six neonates were admitted to NICU with suspected infection; AF or serum HS-CRP levels were not significantly different. CONCLUSION: AF HS-CRP levels were significantly higher after emergency CS. Changes in AF HS-CRP levels were not associated with early post-partum infectious morbidity among mothers and babies, but our findings are limited by small sample size and further study may determine clinical significance.

The frequency and reasons for vaginal examinations in labour

Vaginal examinations (VEs) in labour are a routine part of intrapartum care. Current U.K. guidelines recommend that VEs are offered to women at regular intervals of not less than 4h and only performed when justifiably necessary. However, justification may be interpreted differently by different midwives. This study aimed to investigate (i) the number of VEs performed in relation to length of labour and (ii) the reasons given by midwives for performing the VE. This study recruited a group of women (n=144) admitted in either spontaneous labour or for induction of labour from one NHS hospital in Scotland. The number of VEs performed, the reason provided by the midwife for its need and the length of labour were all recorded. The number of VEs carried out (mean 2.9, SD 1.5, range 1-7) increased as length of time in labour in hospital increased. Approximately half the sample (52%) had 3 or more VEs during labour. Almost 70% of women had more VEs than expected when the criteria of 4 hourly VEs was applied. The most common reason given by midwives for performing a VE was to assess labour progress and to assess the commencement of labour. Despite maternity care policy to limit interventions in normal labour, we found that a substantial number of women received more VEs than was consistent with adherence to guidelines. However, until further research is conducted to validate other measures of labour progress, the number of VEs undertaken during labour is unlikely to decrease.

Retrospective study assessing impact of changes in ‘management of normal labour’ guidelines

BackgroundOur hospital guidelines were updated following the publication of the National Institute for Health and Clinical Excellence guidelines on intrapartum care.The most significant differences were the change from 3 hourly...

‘I'm just going to wash you down’: sanitizing the vaginal examination

This paper reports findings from an ongoing study exploring the qualitative experiences of midwives and women in relation to vaginal examination in labour, focusing on how vaginal examination is discussed and on the wash-down procedure used by some midwives. The body is a source of considerable ambivalence in sociological terms. Women's bodies, in particular, have been viewed as problematic and as a potential source of dirt and pollution. It has been suggested that vaginal examinations during labour are used, at least in part, as a ritual procedure by which healthcare professionals demonstrate that they are in control of both the labouring woman and the process of labour itself. Methods. In-depth interviews were undertaken during 2003 with six childbearing women and 10 midwives who had been involved in these women's care. Non-participant observation was also carried out of each woman's labour and birth. During interviews, when discussing vaginal examination, midwives persistently used abbreviations or euphemisms as a means of distancing themselves from the realities of the procedure. Some midwives were observed washing women's genitals in a highly ritualized manner prior to vaginal examination, apparently as a strategy for establishing power differentials. Midwives commonly state that they are advocates for woman-centred care but their behaviour in relation to vaginal examination belies this and suggests that they regard women's bodies as contaminated and polluting. Healthcare students need to be taught specific communication skills to enable them to discuss vaginal examination more fully with women so that they feel less need to resort to euphemisms and abbreviations when discussing the procedure. It is also important to carry out vaginal examination in a way that is not demeaning and does not reinforce notions that women's bodies are dirty.

Women's experiences of vaginal examinations in labour

To investigate women's perceptions of their experiences of vaginal examinations in labour. A prospective, analytic survey design using anonymised, self-completion, postal questionnaires. A multi-centre study conducted in 2002 in three midwifery units in Cambridgeshire, England. An unselected, consecutive sample of 104 primiparae expected to deliver their first baby in hospital after an uneventful pregnancy at 37 weeks or over, with the fetal head presenting, of whom 73 finally took part; the response rate was 70%. On the basis of a 20-item Likert-type scale, a notional satisfaction index score of 74% was calculated. This was based on 1435 items of ordinal data, suggesting an encouraging measure of contentment with the privacy, dignity, sensitivity, support and frequency with which vaginal examinations in labour were managed. However, there was some scope for improvement in areas such as associated pain, opportunities to refuse examinations and more detailed information-giving. No statistically significant differences in women's perceptions could be demonstrated in the three midwifery units in relation to the numbers of vaginal examinations carried out in labour or the women's perceptions of their care by health professionals. Evidence based on the women's perceptions indicates that 53% of women were more than satisfied with the conduct of their vaginal examinations in labour; a further 44% were satisfied; and the remaining 3% were less than satisfied.

Informing women during vaginal examinations

In a small, multi-centre study conducted in three maternity units in Cambridgeshire, England, a prospective, analytical survey design employing postal questionnaires was used to investigate women's experiences of vaginal examinations in labour. An unselected, consecutive, random sample of 104 primiparae participated in the research of whom 73 returned completed questionnaires, a response rate of 70%. Regarding information-giving during vaginal examination in labour, approximately two thirds of women rated the information provided by midwives as good or very good, the equivalent figure for doctors being one third. A Likert scale addressing ten broad elements of information-giving generated a total of 715 responses of which 63% were positive, 18% were negative and 19% were in between. These findings suggested, on average, that while three fifths of women reported positive experiences of information giving, almost a fifth had negative experiences overall and a further fifth also had, mediocre communication experiences related to their vaginal examinations in labour.

Hong Kong Chinese women's experiences of vaginal examinations in labour

Objective: to explore women's experiences during vaginal examinations in labour. Design: qualitative with phenomenological approach. Data were collected by tape-recorded open-ended interviews during the early postnatal period. Data analysis: phenomenological hermeneutic analysis based upon Riceour's interpretation theory. Participants: a purposive sample of eight women post-delivery who had given birth vaginally and were able to speak and read Chinese. Setting: a maternity unit of a University affiliated District General Hospital in Hong Kong. Key findings: women accepted the necessity for vaginal examinations, but expressed the need to be able to trust that the examiner would respect them as individuals and try to maintain their dignity, perform the examination skillfully and communicate the findings to them. Pain and embarrassment were frequently experienced during vaginal examination. Women wanted to be supported during the examination by someone they knew and trusted; they appreciated practitioners who tried to minimise their physical and psychological discomfort. Some women felt embarrassed when examined by a male doctor, but the attitude and approach of the examiner was generally found to be more important than gender. Implications for practice: practitioners should be continuously aware of the need to show respect and consideration for the dignity of a woman undergoing vaginal examination in labour. Although this seems an obvious statement to make it is reiterated because some practitioners display insensitivity in this regard. Each woman should be treated with courtesy and respect, and her modesty protected by minimal exposure and examiners/examinations. Findings from the examination should be discussed with her. Practitioners should be aware of the cultural influences that may lead a woman to hide her pain during examination and should be alert for signs of this.

Puerperal sepsis: a preventable post-partum complication.

Patients with puerperal sepsis following delivery at Ife State Hospital (ISH) of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife over a 10-year period spanning January 1986 to December 1995 were reviewed. One hundred and forty-six patients were diagnosed as having puerperal sepsis and there were 8428 deliveries giving an incidence of 1.7%. The incidence was higher among the unbooked patients 71.2%. Predisposing factors were: anaemia in pregnancy, 69.2%; prolonged labour (labour lasting up to 12 h or more), 65.7%; frequent vaginal examinations in labour (more than five), 50.7%; premature rupture of membranes, 31.5%; and non-adherence to asepsis during delivery. The case mortality rate was 4.1%. Antenatal care and supervised hospital delivery should be encouraged in order to prevent or reduce this serious post-partum morbidity.

Management of Prelabour Rupture of the Membranes in Term Primigravidae

GRANT, JOHN M.; SERLE, ELISABETH; MAHMOOD, TAHIR; SARMANDAL, PURNIMA; CONWAY, DAVID I. Author Information

Is vaginal examination in labour a significant cause of genital tract infection?

Acta Obstetricia et Gynecologica ScandinavicaVolume 39, Issue 2 p. 316-322 Is Vaginal Examination in Labour a Significant Cause of Genital Tract Infection? Teit Kærn, Teit Kærn The Department of Obstetrics (Teit Kœrn, M.D.), St. Joseph's Hospital, Copenhagen, DenmarkSearch for more papers by this authorJørgen Glenert, Jørgen Glenert The Department of Obstetrics (Teit Kœrn, M.D.), St. Joseph's Hospital, Copenhagen, DenmarkSearch for more papers by this author Teit Kærn, Teit Kærn The Department of Obstetrics (Teit Kœrn, M.D.), St. Joseph's Hospital, Copenhagen, DenmarkSearch for more papers by this authorJørgen Glenert, Jørgen Glenert The Department of Obstetrics (Teit Kœrn, M.D.), St. Joseph's Hospital, Copenhagen, DenmarkSearch for more papers by this author First published: January 1960 https://doi.org/10.3109/00016346009159928AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume39, Issue2January 1960Pages 316-322 RelatedInformation