Pregnancy

Pelvic Exam During Pregnancy

Pelvic Exam During Pregnancy: Vaginal Examinations

During pregnancy, you’re likely to have a number of prenatal check ups with your care provider. These check ups are to monitor your health and wellbeing, as well as to check on the growth and development of your baby.

Some doctors and midwives offer pelvic examinations as part of their prenatal care.

Although there are reasons why a vaginal examination might be necessary during pregnancy, it’s still an intervention, and every woman should know the risks and benefits before having one.

If you’ve talked to experienced mothers, you might assume prenatal vaginal exams are a normal and necessary part of care. While there are cases where vaginal exams can be helpful prior to labour, in a healthy term pregnancy they don’t usually provide any necessary information.

What Is A Pelvic Exam?

A pelvic exam is a procedure in which the doctors assess the vagina and the adjoining organs of the pelvis. Usually, vulva, cervix, uterus, Fallopian tube, ovaries, bladder and rectum are examined during a pelvic exam.

Reasons for a vaginal examination

Some medical reasons to perform a vaginal examination during pregnancy may include the following:

Performing a pap test

Pap tests are recommended for women at least every 2 years. More often if past pap tests have been irregular or abnormal, or showed cell changes that required medical treatments. If you are due to have a pap test during your pregnancy, your caregiver may discuss doing one as part of your first pregnancy visit. However, you may both decide that it is not urgently needed and consider delaying the test until your 6 to 8 week postnatal check, after the baby is born. You can read more in pap test.

Checking signs of an infection

The hormones of pregnancy affect a woman’s entire body, including the environment of her vagina. Part of this can be to slightly alter the vagina’s acidity (or pH), making the woman more prone to annoying fungal infections (such as thrush) or an overgrowth of vaginal bacteria (called ‘Gardnerella’). If you think you have a vaginal infection (or perhaps a sexually transmitted infection) your caregiver will need to look at your genitals and probably do a vaginal examination with a speculum to help make a diagnosis. If required, they will also take swab tests to send to the pathologist for testing.

Looking for a cause of bleeding

If you experience bleeding during your pregnancy your caregiver may want to do a vaginal examination to try and find out the cause of the bleeding. Sometimes a vaginal bleed can be the result of a polyp (a small piece of tissue overgrowing, similar to a skin tag), which can be seen if the caregiver uses a speculum . Polyps may start to bleed on their own, or the bleeding may be triggered through rubbing with sexual intercourse. You may wish to read more in bleeding during middle to late pregnancy.

Preventing medical induction

Some caregiver use vaginal examinations during the final weeks of pregnancy in the hope of preventing a woman from going overdue or requiring an induction of labour using medications. This technique is called ‘sweeping (or stripping) the membranes’ sometimes referred to as a ‘strip and stretch’. Sweeping the membranes is an old method of induction that was first documented in 1810. It can also be used in an attempt to ripen the woman’s cervix, to make it more ‘favourable’ for induction.

Sweeping the membranes involves the caregiver performing a vaginal examination, placing 1 or 2 of their fingers through the opening of the woman’s cervix and then separating the membranes or sac (holding the waters and baby), from their slight attachment to the lower segment of the uterus. The aim is to trigger a local release of prostaglandin hormones by the cervix and perhaps induce labour. Sweeping the membranes can be quite uncomfortable for the woman, and often results in her experiencing period-like cramping (or irregular contractions) and sometimes a small amount of bright red bleeding for 24 hours or so afterwards.

There are some caregivers who recommend routinely performing this procedure at the weekly pregnancy visits from 37 to 38 weeks, until the labour starts (or an induction is required). This is aimed at preventing the woman from going more than 41 to 42 weeks overdue (and in some cases an induction). Studies looking at the success of sweeping the membranes have shown there is a slight statistical advantage to having this performed routinely, although the benefits are small and unpredictable. This must be weighed against the discomfort it can cause the woman and the real chance that the intervention does not succeed. You can read more in sweeping the membranes.

When Is Pelvic Exam Performed During Pregnancy?

Usually, pelvic exam is performed during the first and third trimester unless there is some complication in the pregnancy and the pregnant woman needs continuous monitoring.

  1. During the first trimester, the pelvic exam is conducted where the doctor checks whether the cervix is been properly sealed with mucus plug. The tests like Pap smear are also conducted during the first trimester of pregnancy. If nothing is wrong in test results, no more pelvic exams are done up to the 36th week of pregnancy
  2. After the 36th week of pregnancy, the doctor will do pelvic exam more frequently or even on every visit. This is to monitor the effacement and dilation of the cervix so that it will be easy to determine how near the delivery is
  3. A doctor may also do pelvic exam more frequently if there are any of the following complications and it requires close monitoring :
  • If you have a medical condition that increases risk of a preterm labor
  • If you experience spotting
  • If you experience some vaginal infections (like genital herpes)
  • If there is some growth in pelvic area

How a vaginal examination is done

A vaginal examination can be done by the caregiver using:

Their gloved fingers: This involves the woman partially undressing from the waist down and lying on her back on the bed, resting comfortably with her knees bent, feet together and allowing her knees to fall comfortably apart. The caregiver usually puts a small amount of white antiseptic cream on their gloved fingers (or K-Y gel if the woman knows she is allergic to the Hibitane in the cream) and places their first 2 fingers inside the woman’s vagina until they feel her cervix. If they are also feeling the uterus (when less than 12 weeks pregnant), they will use their other hand on the top of the woman’s abdomen, to try and feel the top of the uterus.

A speculum: This is a metal or plastic instrument, shaped a little like a duck’s bill. The woman needs to lie on her back on the bed and rest comfortably with her knees bent. Her bottom needs to rest on the lower edge of the bed and her feet are usually placed on a slightly lower platform, at the bottom of the bed (or on specially designed footrests). This position helps the caregiver use the speculum correctly and makes the procedure more comfortable for the woman. The end of the speculum is warmed in water before the caregiver gently slides it into the woman’s vagina. Once in place, the caregiver uses the handle on the speculum to slowly open the ‘bills’ of the instrument. This separates the walls of the vagina, allowing the caregiver to look inside and view the woman’s vagina and cervix.

During a vaginal examination with either method, the caregiver should always try and direct the pressure from their fingers or the speculum downwards, more towards the woman’s bottom. This makes the examination more comfortable. It also helps if the woman takes some slow, deep breaths and consciously tries to relax her bottom. This then relaxes her pelvic floor muscles, making them less tense, helping make the procedure more comfortable for the woman and easier for the caregiver to perform.

How Is Pelvic Exam Performed During Pregnancy?

Usually, examination of the size, shape and position of the pelvic organs are done during a pelvic exam.
A pelvic exam includes two components – manual and visual. Manual assessment includes the examination of the external genitalia (vulva) and inside the vagina for an internal assessment of the vaginal walls. The visual examination is performed with a small device called speculum which allows a clear view of all the pelvic organs which helps in easy evaluation.

  • While performing a pelvic examination, you will be required to remove your lower clothing and lie on your back on the examination table
  • The doctor will ask you to draw your knees up and spread them wide apart
  • He will place a gloved index and middle finger into the vagina and assesses the cervix
  • A speculum exam is the next step. During this exam, a speculum, which is a hollow cylinder with a rounded end that is divided into two hinged parts, fairly like the mouth of a duck, is used. The speculum is inserted into the vagina to expand it for examination. When inside, the two halves of the speculum will open up, making it easier for the doctor to examine the cervix and the upper part of the vagina

The Pap smear test is conducted during this time of the pelvic examination

Bladder and rectal examination are also usually included in a pelvic exam to rule out the chances of UTI and hemorrhoids
During the final weeks of pregnancy, pelvic exam is performed to find out:

  • Effacement and dilation of cervix
  • Position of the cervix
  • How far into the pelvis the baby is descended
  • Presentation of the baby

The pelvic exam towards the final week of the pregnancy also has an advantage. The pelvic exam has higher chances to stimulate the cervix so that labor induction is not necessary.

Are There Risks In Pelvic Exam During Pregnancy?

Pelvic exam has its own risks during pregnancy:

  • The risk of infection increases even though the doctor uses sterile gloves. This is because there are chances of the bacteria from the vagina being pushed up towards the cervix
  • As already mentioned, the examination can stimulate the cervix and initiate labor and if you are not due or your baby is not ready to be born, it can increase the chances preterm labor
  • Pelvic exam has a chance to cause PROM(premature rupture of membrane)
  • After a pelvic exam, the pregnant women are usually told as to how many centimeters they are dilated and when can they expect to go in labor. If the days pass and still there is no sign of labor, it can make the pregnant woman anxious and in this anxiety she can give her consent or request for labor induction

If your doctor insists on a pelvic exam, you should ask him for specific reason for the exam, what he is trying to find out and if in any way it will affect your pregnancy or delivery. If you are not convinced about having a pelvic exam, you have a right to decline it or request a second opinion. If you decide to go ahead with the exam, here are following things you should keep in mind:

  • Your bladder is empty
  • You are comfortable and properly covered
  • Ensure your privacy
  • Breathe deeply and relax your pelvic floor muscles. This will decrease the discomfort of the exam

Deciding to go in for a pelvic examination during pregnancy should be totally on you. You should understand why the exam is suggested and what the doctor is trying to find out and how it is going to help in your pregnancy. A doctor cannot perform the pelvic exam without explaining you the procedure and taking your consent.

What If My Care Provider Tells Me I Must Have A Pelvic Exam?

If your care provider insists on a pelvic exam, it’s important to know why. Ask for the specific reason for the exam, what it aims to find out, and how it will alter anything for your pregnancy or birth.

If you aren’t convinced there’s a good reason for a pelvic exam, then you are within your rights to decline it, or to request a second opinion.

If you decide to go ahead with the exam, make sure your bladder is empty, and that you are warm, comfortable and properly covered. Your privacy must be ensured and no extra staff should be present unless you wish. Breathe deeply and relax your pelvic floor muscles to limit discomfort.

Having a pelvic examination during pregnancy should be something you decide only after having all the facts. You should understand why the exam is being suggested, what your care provider hopes to find out, and how this information will help. The procedure must be explained to you and your informed consent must be obtained.

Reviewed by the QSota Medical Advisory Board

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