The correlation between the number of vaginal examinations during active labor and febrile morbidity, a retrospective cohort study

Ohad Gluck, Yossi Mizrachi, Hadas Ganer Herman, Jacob Bar, Michal Kovo, Eran Weiner, Ohad Gluck, Yossi Mizrachi, Hadas Ganer Herman, Jacob Bar, Michal Kovo, Eran Weiner

Abstract

Background: The association between the number of vaginal examinations (VEs) performed during labor and the risk of infection is unclear. The literature regarding this issue is not consensual, and the available studies are relatively small. Therefore, we aimed to study the association between the number of VEs during labor, and maternal febrile morbidity, in a very large cohort.

Methods: This is a retrospective cohort study. All women who delivered vaginally ≥37 weeks, at our institute, between 2008 and 2017 were included. Patients who underwent cesarean delivery or who were treated with prophylactic antibiotics, or had a fever ≥38.0 °C prior to the first VE were excluded. Cases of intrauterine fetal death, known malformations, or missing data were excluded as well. The cohort was divided according to the number of VEs performed: up to 4 VEs (n = 9716), 5-6 VEs (n = 4624), 7-8 VEs (n = 2999), and 9 or more VEs (n = 4844). The rates of intrapartum febrile morbidity (intrapartum fever and chorioamnionitis), postpartum febrile morbidity (postpartum fever and endometritis), and peripartum febrile morbidity (any of the mentioned complications) were compared.

Results: Overall, 22,183 women were included in the study. On multivariate analysis, we found that performing 5 VEs or more during labor was independently associated with intrapartum febrile morbidity (5-6 VEs: aOR = 1.83, 95% CI (1.29-2.61), 7-8 VEs: aOR = 2.65 95% CI (1.87-3.76), 9 or more VEs aOR = 3.47 95% CI (2.44-4.92)), postpartum febrile morbidity (5-6 VEs: aOR = 1.29, 95% CI (1.09-1.86), 7-8 VEs: aOR = 1.94 95% CI (1.33-2.83), 9 or more VEs aOR = 1.91 95% CI (1.28-2.82)), and peripartum morbidity (5-6 VEs: aOR = 1.48, 95% CI (1.15-1.91), 7-8 VEs: aOR = 2.15 95% CI (1.66-2.78), 9 or more VEs: aOR = 2.57 95% CI (1.97-3.34)).

Conclusion: The number of VEs performed during labor is directly correlated with febrile morbidity. Performing five or more VEs during labor is independently associated with febrile morbidity; For intrapartum and peripartum febrile morbidity the risk rises as more VEs are performed.

Keywords: Febrile morbidity; Intrapartum fever; Postpartum fever; Vaginal delivery; Vaginal examination.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

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Fig. 1
Cohort analysis flowchart

References

    1. Downe S, Gyte GM, Dahlen HG, Singata M. Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term. Cochrane Database Syst Rev. 2013:7 [cited 2018 13 Oct].
    1. de Klerk HW, Boere E, van Lunsen RH, Bakker JJH. Women’s experiences with vaginal examinations during labor in the Netherlands. J Psychosom Obstet Gynecol. 2018;39(2):90–95. doi: 10.1080/0167482X.2017.1291623.
    1. (UK) NCC for W and CH. Normal labour: first stage. 2007 [cited 2018 13 Oct].
    1. Borders N, Lawton R, Martin SR. A Clinical Audit of the Number of Vaginal Examinations in Labor: A NOVEL Idea. J Midwifery Womens Health. 2012;57(2):139–144. doi: 10.1111/j.1542-2011.2011.00128.x.
    1. Newton ER. Chorioamnionitis and intraamniotic infection. Clin Obstet Gynecol, 1993. 36(4):795–808 [cited 2018 1 Nov].
    1. Gibbs RS, Duff P. Progress in pathogenesis and management of clinical intraamniotic infection. Am J Obstet Gynecol. 1991;164(5 Pt 1):1317–1326. doi: 10.1016/0002-9378(91)90707-X.
    1. Duff P. Maternal and perinatal infection — bacterial [internet]. Seventh Ed. Obstetrics: Normal and Problem Pregnancies. Elsevier Inc.; 2012. 1140–1155 p.
    1. Soper DE, Mayhall CG, Froggatt JW, Baker ME, Hopwood H, Nesbitt T, et al. Characterization and control of intraamniotic infection in an urban teaching hospital. Am J Obstet Gynecol. 1996;175(2):304–310. doi: 10.1016/S0002-9378(96)70139-4.
    1. Seaward PG, Hannah ME, Myhr TL, Farine D, Ohlsson A, Wang EE, et al. International multicentre term prelabor rupture of membranes study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. Am J Obstet Gynecol. 1997;177(5):1024–1029. doi: 10.1016/S0002-9378(97)70007-3.
    1. WHO recommendations: Intrapartum care for a positive childbirth experience. 2018 [cited 2018 13 Oct].
    1. Shepherd A, Cheyne H. The frequency and reasons for vaginal examinations in labour. Women Birth. 2013;26(1):49–54. doi: 10.1016/j.wombi.2012.02.001.
    1. Cahill AG, Duffy CR, Odibo AO. Number of Cervical Examinations and Risk of Intrapartum Maternal Fever. 2012;119(6):1096–101.
    1. Soper DE, Glen Mayhall C, Dalton HP. Risk factors for intraamniotic infection: A prospective epidemiologic study. Am J Obstet Gynecol. 1989;161(3):562–568. doi: 10.1016/0002-9378(89)90356-6.

Source: PubMed

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