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


Downe, S., et al

Subject Keywords: o 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
Type: Article
Region: International (other)

For a baby to be born, the mother's cervix needs to change from being closed to being open to about 10 centimetres (‘dilated’). Vaginal examinations provide information on how widely dilated the cervix is, how much it has thinned and the position of the presenting part of the baby in the mother's pelvis. This is part of assessing the woman's progress in labour, although knowing the dilation of the woman's cervix is a poor predictor of when she will give birth. Patterns and speed of labour can vary substantially between different women, and in the same woman in different labours. Very slow labours can be associated with difficulties for both the mother and baby. Abnormally slow labours (dystocia) can sometimes lead to neurological problems in the baby and long-term urinary and fecal incontinence in the mother, especially in low-income countries. Vaginal examinations aim to reassure the woman (and staff) that the woman is labouring normally, and to provide early warning if this is not the case. In low-income countries, it can take some time to get to help, and vaginal examinations may enable appropriate transfer from community settings to hospital care. If labours that are slow, but not abnormal, are mis-diagnosed as being abnormal, this can lead to unnecessary interventions such as drugs to try to speed labour on or caesarean section or forceps for giving birth. There are also concerns about introducing infection to the uterus and to the baby, especially in low-income countries where disposable gloves, or reusable gloves and disinfectants, are not readily available. In addition, some women find the process of vaginal examinations uncomfortable or distressing, and so it is important that there is good evidence for its use. We looked for studies to see how effective routine vaginal examinations in labour are at reducing problems for mothers and babies.

The authors found two studies, undertaken in the 1990s in high-income countries, but their quality was unclear. One study, involving 307 women, compared routine vaginal and rectal examinations in labour. Here, fewer women reported that vaginal examinations were very uncomfortable compared with rectal examinations. The other study, involving 150 women, compared two-hourly and four-hourly vaginal examinations, but no difference in outcomes was seen.

the authors identified no convincing evidence to support, or reject, the use of routine vaginal examinations in labour, yet this is common practice throughout the world. More research is needed to find out if vaginal examinations are a useful measure of both normal and abnormal labour progress. If vaginal examination is not a good measure of progress, there is an urgent need to identify and evaluate an alternative measure to ensure the best outcome for mothers and babies.



Rights: © The Cochrane Collaboration
Suggested citation:

Downe, S., et al. (2013) Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term [Online]. Available from: [Accessed: 23rd July 2019].


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