When to Avoid Vaginal Examinations in L&D

For most L&D nurses, vaginal examinations have almost become routine procedure and are often performed without much forethought for negative consequences.

Although a quick digital vaginal examination can deliver an abundance of information in terms of cervical effacement, dilatation, membrane integrity and fetal position and station, it is inherently an invasive procedure that may be risky in certain situations.

Digital vaginal examinations should be completely avoided in any high risk delivery or a labor with a history of vaginal bleeding. In these circumstances, the nurse should never perform a vaginal or rectal examination or take any action that would further stimulate uterine activity. Performing a digital examination can cause severe bleeding and compromise fetal status further. High risk deliveries include placental anomalies (such as placenta previa, where the placenta partially or fully covers the cervical os) and premature labor (less than 38 week gestation).

Limiting vaginal examinations cannot be overemphasized. Women with pre-labor rupture of membranes should not receive digital vaginal examinations until after labor begins and then only when the results are necessary to guide or alter management.