Potential excess of vaginal examinations during the management of labor: frequency and associated factors in 13 Peruvian hospitals

Abstract

Background A high number of vaginal examinations (VEs) may lead to a higher risk of infections, as well as discomfort/dissatisfaction with intrapartum care. Objective To determine the frequency of potential excess of vaginal examinations (PEVE) during the management of labor and identify its associated factors, in Peruvian hospitals. Methods Secondary analysis of the data collected in the DisrespEct and abuse during ChIlDbirth in pEru (DECIDE) study, held between April and May 2016. In this study, women hospitalized in Peruvian hospitals right after giving birth were surveyed by trained personnel. PEVE, the main outcome, was considered as five or more vaginal examinations (VEs) performed during the management of labor. Poisson regression models with robust variance were performed to calculate crude and adjusted prevalence ratios (cPR and aPR) as well as their 95% confidence intervals (95% CI). Results One thousand four hundred twenty registries of 13 hospitals from 8 Peruvian cities were evaluated. The number of women studied at each hospital ranged between 100 and 129. The median age was 26 years (interquartile rank: 22–31). The median number of VEs was 3 (interquartile rank: 2–5). The proportion of women who underwent PEVE was 33.9%, this ranged from 0.9 to 69.9% at the studied hospitals. The frequency of PEVE was higher in women who attended > 2 obstetric psychoprophylaxis sessions, compared to those who attended ≤ 2 sessions (aPR: 1.78 95% CI: 1.01–3.12); and among women who gave birth between 18:00 h and 23:59 h, compared to those who did it between 7:00 and 17:59 h (aPR: 1.28 95% CI: 1.04–1.57). Conclusion Around one in three women underwent a PEVE, although this frequency varied widely across the evaluated hospitals. Women with more psychoprophylaxis sessions, and who gave birth between 18:00 h and 23:59 h, had a higher PEVE frequency. Future studies should assess in depth the causes and consequences of this high frequency.

Designing a respectful maternity care guideline: a multiphase study

“…Furthermore, since the existing studies [ 29 – 32 ] concur with the recommendations of the labor and delivery of the guideline proposed by this study with regard to the necessity of involving women in the care process, women’s awareness should be raised about care and intervention. In fact, they should be involved in clinical decision-making [ 29 ] so that parturient women can act freely [ 30 ].…”

“…The panel of experts also had a consensus in this regard and stated that frequent vaginal examinations should be avoided without acquiring permissions or proper justification of the parturient women. Tanaka et al [ 32 ] concluded that the number of examinations were more than 40% (5 and more) and vaginal examinations were 1.5 times more at night than daytime [ 32 ].…”

Risk factors associated with severe perineal lacerations during vaginal delivery: a 10-year propensity score–matched observational study

“…A standard obstetrical practice is to examine a woman in active labor approximately every 2 to 4 hours; therefore, a cutoff of ≥5 obstetrical examinations is often used to indicate a high frequency of inspections. 36 , 37 , 38 , 39 Here, we assessed the relationship between frequent obstetrical examinations in labor and increased risk of severe perineal trauma and showed a positive trend toward increasing the risk of OASIs; however, our results were underpowered to draw solid conclusions. The study by Gluck et al 40 is, to the best of our knowledge, the only study to examine the association between OASIs and the frequency of obstetrical examinations on a cohort of 22,387 laboring women.…”

A Prospective Study of the Benefits of Simulators in Improving Beginnersʼ Obstetric Vaginal Examination Skills

“…Teaching technical skills during medical training can present many ethical and medico-legal issues (1) . Vaginal examination is a procedure used frequently during the management of labor, especially to assess its beginning and to evaluate its progress (2) .…”