Infection Caused by Internal Examinations

Heather’s  comment – just stating the obvious. . .
A group of obstetricians in Ohio has looked at bacteria present around the cervix before and after vaginal examinations.

35 women in labour (25 of them with ruptured membranes) had a speculum examination and at the same time a sample of fluid was taken to check bacteria. After this the cervix was examined by a doctor wearing a sterile glove. Then they had a second speculum examination and another sample was taken.

The first sample showed an average of 2.8 different kinds of organisms, the second showed 4.4. In 20 of the women there was an increase in quantity of at least one of the bacteria;, and women with ruptured membranes were more likely to have such an increase.

Although this was not a randomised study, the doctors did do two speculum examinations without a digital examination in between on 5 women, and the number of organisms did not increase in them.

As the authors point out “An immediate effect of digital examination of the cervix is the introduction of vaginal organisms into the cervix.”

AIMS Comment

Yet another study showing the relationship between VEs in labour and increased infection risk.

The women were apparently recruited to the study after they entered the hospital in labour. By the standards of the AIMS/NCT Charter for Ethical Research in Maternity Care, they should have been fully informed of the study during pregnancy in order to give valid consent under the stress of labour or ruptured membranes.

  • Imseis H, et al, The microbiologic effect of digital cervical examination, Am J Ob Gyn, 1999; 180: 578-80