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Abstract Background Predicting the success of vaginal delivery is an important issue in preventing adverse maternal and neonatal outcomes. Thus, this study aimed to compare the success rate of vaginal birth by using trans-labial ultrasound and vaginal examination, and vaginal examination only in pregnant women with labor induction. Methods This was a comparative study including 392 eligible pregnant women with labor induction attending to a teaching hospital affiliated with Iran University of Medical Sciences from April to October 2018 in Tehran, Iran. Women were randomly assigned to two groups; the trans-labial ultrasound plus vaginal examination (group A), and the vaginal examination only (group B). Women were included in the study if they satisfied the following criteria: singleton pregnancy, 37 to 42 weeks of gestational age, fetal head presentation, a living fetus with no abnormalities, uncomplicated pregnancy, and no previous cesarean section or any uterine surgery. We used a partograph for both groups to assess the fetal head position and the fetal head station. In group 1, the Angle of Progression (AoP) and Rotation Angle (RA) were also assessed. Finally, the success and progression of vaginal delivery in two groups were compared by predicting the duration of delivery and mode of delivery. Results The findings showed that 8.68% of women in the trans-labial plus vaginal examination group delivered by cesarean section, while 6.13% in the vaginal examination only group delivered by cesarean section (P = 0.55). In women with cesarean section in positive fetal head stations, Angle of Progression (AoP) was significantly decreased ranging from 90 to 135 degrees compared to women who delivered vaginally (135–180 degrees; P

Introduction: Our objective was to compare the performance of the first vaginal examination at 8 vs 4 h after amniotomy following Foley ripening in nulliparous labor induction. Material and Methods: A randomized controlled trial was conducted from June 2021 to January 2022. 210 nulliparas at term for labor induction were randomized: 105 each to first vaginal examination at 8 or 4 h after Foley balloon ripening and amniotomy. Titrated oxytocin infusion was routinely commenced after amniotomy to expedite labor. Primary outcomes were the amniotomy‐to‐delivery interval (non‐inferiority hypothesis) and maternal satisfaction with their allocated labor care (superiority hypothesis) within 24 h after delivery. Analyses performed using t‐test, Mann–Whitney U test, and Chi‐squared test as appropriate. Results: The amniotomy‐to‐delivery interval was mean ± standard deviation 8.7 ± 3.4 vs 8.4 ± 3.7, mean difference 0.4 (97.5% CI: −0.7 to 1.5) hours, p = 0.442 within the pre‐specified 2‐hour non‐inferiority margin, and maternal satisfaction score with allocated labor care was median [interquartile range] 8[7.5–10] vs 8[7.0–10], p = 0.248 for 8 vs 4 h arms, respectively. The amniotomy to first vaginal examination intervals was 5.9 ± 2.3 vs 3.6 ± 1.0 h, p < 0.001, and the number of vaginal examinations was 2[1–2.5] vs 3 [2, 3], p < 0.001 for 8 vs 4 h, respectively. The first vaginal examination was less likely to have been performed as scheduled, more likely to be indicated by the urge to bear down, and non‐reassuring cardiotocography for the 8 h arm (p < 0.001). Spontaneous vaginal delivery was significantly more likely and instrumental vaginal delivery less likely, but cesarean rate was not significantly different for the 8 h arm (p = 0.017). Conclusions: A routine first vaginal examination at 8 h compared to 4 h is non‐inferior for the time to birth but does not increase maternal satisfaction although the number of vaginal examinations is fewer. The increase in spontaneous vaginal delivery and reduction in instrumental vaginal delivery rates warrant further powered primary evaluation. [ABSTRACT FROM AUTHOR]

Objective: To determine the number of sessions required using procedural simulation to acquire the skill of vaginal examination, which is an essential part of obstetrics, but a difficult learned skill., Methods: Using a high-fidelity simulator, we conducted a prospective, single-center, single-blind study, at the Angers School of Midwifery. A class of students completed a theory course, and took part in three simulation sessions. During the simulation sessions, each student was asked to describe five different cervixes, under five criteria: position, length, consistency, dilation, and head station. Each participant received individual feedback as part of a debrief session, after completing their description. A pass rate of 80% was set for the entire class., Results: Twenty-six students participated. The class achieved a mean score of 70.77 ± 10.23% in the first session, 81.85 ± 9.91% in the second session, and 81.23 ± 8.63% in the third session. There was a significant improvement only between the first and second sessions (P < 0.001). Of the 26 participants, 6 (23%) scored over 80% in the first session, 17 participants (65%) scored above 80% in the first two sessions, and 21 participants (80%) scored above 80% over the three sessions., Conclusion: Learning vaginal examination by procedural simulation with the aid of a high-fidelity simulator, and receiving individual feedback and debrief, resulted in an 80% pass rate in two practical sessions, working to describe 10 cervixes., (© 2024 International Federation of Gynecology and Obstetrics.)

Urovagina and purulent vaginal discharge (PVD) are usually diagnosed using a speculum, Metricheck device, or gloved hand. In periestrous dairy cows, a comparative study of these vaginal examinations for diagnosing urovagina or PVD has not yet been conducted. This study aimed to identify an effective vaginal examination method for periestrous dairy cows to ensure successful artificial insemination. Data were collected from 227 Holstein-Friesian cows during 300 occurrences of spontaneous estrus. Urovagina was evaluated using the speculum and gloved-hand methods and classified as mild, moderate, or severe. Vaginal discharge was evaluated using speculum, Metricheck, and gloved-hand methods and classified as vaginal discharge score (VDS) 0-5, with 2-5 defined as PVD-positive. Sensitivity and specificity of the gloved-hand versus speculum method in diagnosing urovagina, speculum versus Metricheck method, and gloved-hand versus Metricheck method in diagnosing PVD positivity were equivalent. The incidence of urovagina tended to be higher with the gloved-hand than with the speculum method. The incidence of PVD positivity tended to be higher with the gloved-hand than with the speculum and Metricheck methods. To analyze the correlation between pregnancy outcomes and mucus characteristics diagnosed using each method, logistic regression analysis was conducted, and the final models were compared. In this model, urovagina was selected as the explanatory variable and was associated with poor pregnancy. The results indicate that the gloved-hand method would be useful for managing fertility by detecting urovagina and PVD in periestrous dairy cows.

Background and objectives Vaginal digital examination and transvaginal ultrasound are routinely for clinical assessment. Many women find these procedures uncomfortable, embarrassing, and stressful. Negative experiences increase anxiety and discomfort experienced during subsequent examinations. Emotional distress and fear of pain result in women avoiding gynaecological screening and follow-up. This study uses qualitative methods to evaluate the experience of patients who have undergone both vaginal digital and transvaginal ultrasound examinations, collectively called pelvic examinations (PE) in the outpatient setting of a tertiary hospital in Singapore. Methods Qualitative semi-structured interviews were conducted on 12 participants aged 30-57 years. Interviews were audio-recorded, transcribed, audited, and analysed iteratively based on grounded theory. Emergent themes were first externally validated and finalized after rounds of deliberations amongst the investigators. This included descriptions and concepts reflecting the most important matters experienced by participants. Results Majority of participants found PE unpleasant and uncomfortable especially when providers were perceived to have poor communication and examination skills. Factors that improve their experience include a conducive environment that is, privacy, dim lights, and warm lubricant. Having adequate information before and during the procedure was important especially for first time. Conclusion Patient-centred care ensures a positive experience in relation to the themes found in this study. Gaps in HCP training on communication and procedure skills should be addressed. Efforts should be made improve the clinic environment and provide adequate information to patients.

Objective: To assess the frequency of digital examination and its associated factors among laboring mothers in public health facilities in Arba Minch town, southern Ethiopia. Digital vaginal examination (DVE) is the commonly applied clinical assessment method used to discover the progress of labor and delivery. However, frequent DVE may not be free of risk for maternal and neonatal health, and pain during intrapartum care., Methods: An institution-based descriptive cross-sectional study was employed from May 3 to July 6, 2022. Study participants were selected by a serial sampling method. Data were entered into epi data version 7.2 and exported to SPSS v.25 for data analysis. Binary and multivariate logistic regression analyses were employed to assess associations between study variables. Statistical significance was declared at a P value less than 0.05., Results: A total of 374 women responded to the interview, making a response rate of 98.4%. In all, 230 (61.5%) of the laboring mothers underwent five or more DVE. Being a primipara, being in latent phase at admission, having augmentation of labor, prolonged labor, being admitted with intact membranes, and vacuum delivery showed significant associations with frequent DVE., Conclusion: Frequency of DVE among laboring mothers is relatively high in the study area. The frequent DVE were mainly caused by healthcare provider's interventions to shorten the time of labor. Emphasis on training and monitoring the practice of healthcare givers would be helpful to mitigate this problem., (© 2023 International Federation of Gynecology and Obstetrics.)

Background and purpose: Vaginal examination is an essential part of obstetric care. Due to cultural influences and the sensitive nature of the subject, there is a need for a precise tool to evaluate that in Iranian women. This study aimed to develop a scale for investigating iranian pregnant women’s perceptions of vaginal examination during labor and evaluate its psychometric properties. Materials and methods: This methodological study was performed in two phases. First, the items were extracted by reviewing relevant literature. Then, the psychometric properties of the instrument were determined by face validity and content validity (qualitative and quantitative assessments), construct validity (exploratory factor analysis and known-group validation), and internal consistency and stability. All data analyses were done in SPSS V19.0. Results: Thirty five items were extracted. After assessing the face and content validity, the items reduced to 29. After exploratory factor analysis the items of the instrument were 26 that indictated five factors. Finally, internal consistency )α= 0.754( and stability )ICC== 0.79( were determined for reliability evaluation by test- retest. Conclusion: According to this study, the Persian Version of Women’s Perceptions of Vaginal Examination (26 items) could be used as a an acceptable instrument for investigating women’s perceptions of vaginal examination during labor, due to good development process and suitable validity and reliability.

Aim: This study aims to determine qualitatively experiences and affecting factors of the women related to vaginal examination during labor. Methods: The study was conducted with 20 normal birth giving women at two state hospitals in a province in Turkey. The data were collected by personal information form, semi-structured interview form and interviewer observation form. The data were analyzed by the content analysis. Results: The average age of women was 34.60 ± 6.40, and 75% (n: 15) of them were multiparous. Two themes were identified as “vaginal examination concept” and “experience and emotional reactions related to the vaginal examination.” The themes affecting the vaginal examination experience were also determined as “affecting life” and “expectations on vaginal examination.” The participants often declared that the examination was performed to assess the progression of childbirth. They also stated that they did not get enough information from the healthcare professionals during the examination process. They declared that the professionals did not pay enough attention to their privacy, and they were exposed to unnecessary and frequent vaginal examinations. According to the results, most of their experiences were negative (especially feelings of shame, pain and loneliness). The healthcare professionals were expected to be friendly and informative. The examination environment was expected to be appropriate in terms of ergonomics. Conclusion: Women expect special attention for their physical and psycho-social care needs during vaginal examination.

Abstract Background This systematic review aimed to investigate the reliability of ultrasound method compared with digital vaginal examinations in detecting cervical dilation. Methods We searched Cochrane (CENTRAL), MEDLINE, EMBASE, CINAHL, ISI Web of Science Core Collection, Trip Database, PubMed, DARE and NHS EED, HTA, and PROSPERO. Ten observational studies with a total sample size of 856 were included in the meta-analysis. Results The intraclass correlation coefficient (ICC) values ranged between 0.21 and 0.69. The fixed-effect models for the ultrasound test showed an average of ICC (r = 0.32 (95% CI 0.26–0.38). Correlation between two methods was poor (r = 0.359, 95% CI 0.26–0.44). In nulliparous and multigravida participants the correlation between ultrasound measurements and digital examinations was (r = 0.349, 95% CI 0.25–0.43) and ICC (r = 0.676, 95% CI 0.419–0.833), respectively. Conclusion Trans-perineal ultrasonography seems to be a reliable method for assessing labor progression in multigravida women, but its usage in nulliparous women needs further studies.

Introduction: Considering that evaluation of fetal head station is difficult and determination by different people had no harmony, therefore, this study was performed with aim to evaluate the accuracy of station meter device (a simple device which is named as determining exact fetal head station that had invention certificate and is approved by Medical Equipment Office) and compare with vaginal examination by obstetrics' resident in order to avoid diagnostic errors. Methods: This cross-sectional study was performed in 2018-2019 on 150 primarous pregnant mothers in the active phase of labor at the maternity ward of Emam Reza and Omol Banin hospitals. At first, the mothers were examined by Obstetrics' resident and fetal head station was recorded in Form A without the knowledge of researcher assistance midwife. Then, the researcher assistance midwife determined the fetal head station with station meter device simultaneously without the knowledge of the result of vaginal examination, and recorded in form B. After data collection, fetal head station was compared in two groups, and correlation and agreement between these two methods were determined by Kapa and Wilcoxon and Spearman tests. Data were analyzed by SPSS software (version 23). PResults: In different fetal head stations, agreement between two measurement methods by Obstetrics' resident and station meter device with Kappa statistics test was 86% and significant (p

Objective: To review the perception of and feedback from medical students on the application of a virtual reality (VR) model to acquire vaginal examination (VE) skills. Methods: A specially designed VR training model on VE was developed with the aim of enhancing medical students' VE skills. Medical students attending the gynecology clinic were invited to try this VR training model. Their participation was voluntary and at the completion of their VR training, they were asked to complete an anonymous questionnaire to give their feedback and perception regarding this learning experience. Results: Sixty‐five sixth‐year medical students completed the VR training and the feedback questionnaire: 55 (84.7%) of them reported that the training instructions were clear and 60 (92.4%) considered the training to the helpful in recalling the details of the tasks. It was also reported that VR technology could facilitate learning and interaction, and motivate learning in 80.1% and 66.2% of medical students, respectively. Conclusion: VR technology is a potential teaching modality for medical students to acquire VE skills. However, further evaluation is needed to determine whether this learning tool is effective in enhancing clinical competence. Synopsis: Virtual reality technology is a potential teaching modality for medical students to acquire vaginal examination skills. [ABSTRACT FROM AUTHOR]

Our aim to conduct the descriptive study was to determine the maternal and neonatal outcomes of frequent vaginal examinations during labor. Data were collected in the first 24 hours, between days 2-5, in week 2 and in week 6 after the birth. No statistically significant correlation was observed between the frequency of vaginal examinations and the development of genitourinary or neonatal infections. On the other hand, it was seen that being a primipara were risk factors for a woman's developing a genitourinary infection while an increase in the number of personnel performing the vaginal examination was a risk factor for a neonatal infection.

Competing Interests: Competing interests: RB is a PhD student supervised by Elselijn Kingma, one of the authors of the feature article and provided comments on the article when in draft. Professor Kingma has not commented on this commentary piece.

Background: Vaginal examination is a procedure used frequently during the management of labor, especially to assess its beginning and to evaluate its progress. Objective: The aim of the current work was to assess the benefits of the use of simulators in improving obstetric vaginal examination to house officers. Subjects and methods: A single-center, prospective study was performed at the Department of Obstetrics and Gynecology, Cairo University Hospitals, between June 2020 and March 2021. It enrolled 39 house officers spending their internship program and 70 women admitted for an uncomplicated delivery. All house officers attended orientation lectures and each student performed vaginal examinations for different conditions of the simulator followed by examination of different patients within emergency department. The overall accuracy score for simulators examination was calculated out of 90 for each participant and compared with the score of patient's examination. Results: There was no statistically significant difference between simulator and patient's examination accuracy score concerning cervical dilatation, presenting part, fetal station, and moulding. Participants were more accurate in assessing effacement after simulator examination compared to their accuracy after real patient's examination. On the other hand, cervical position assessment accuracy was significantly higher after real patient's examination compared to that shown after simulator examination. Overall, students' examination accuracy was not significantly different when comparing both simulators versus real patients. Conclusion: Simulation training has achieved great results using one that is anatomically typical to human female pelvic structure. However, it did not show similarity with real patients when assessing the cervical effacement and position. [ABSTRACT FROM AUTHOR]

Background: Receiving a per vaginal examination (PV) can be a negative experience for the woman. There is no published study on this topic concerning a PV during labor and women also experience labor pain. Thus, it is important to study about experiences of women receiving a vaginal examination during labor. Material and Methods: A descriptive study was performed. Questions regarding the experiences of receiving the first vaginal examination during labor were asked of 81 laboring primiparas in the labor unit in Hatyai Hospital in 2007. Descriptive statistics were used in the analysis. Results: The results showed that receiving PV during labor made women experience pain (n = 41, 50.6%) at a "moderate" level, followed by a "mild" pain (n = 29, 35.8 %). The majority of women experienced "little" discomfort (n = 43, 53.1 %), and no irritation (n = 72, 88.9 %). Some experienced a "little" embarrassment (n = 33, 40.7%). Half experienced "little" fear of PV (n = 41, 50.6%) and some did not fear of PV (n = 29, 35.8%). More than half did not fear of infection from PV (n = 53, 65.4%). Conclusion: Receiving vaginal examination during labor caused majority of the women feelings of pain and discomfort at moderate level. Majority of women did not experience of irritate and embarrassment. Half of the women feared of PV at little level and more than half did not fear of infection from receiving PV.

Objective: To assess perceptions about vaginal examinations (VEs) during labor among women referred to the Akbarabadi Hospital in Tehran, Iran. Methods: This was a cross-sectional study conducted from December 2015 to May 2016. It included 200 primiparous women. Convenience sampling was used to select participants. The data collection tool was a questionnaire that collected both demographic and obstetric data from participants, as well as data in relation to women’s experiences according to a designated and validated scale, 24 hours after childbirth. Higher scores were indicative of a more positive perception in relation to a participant’s experience of VE. Results: The mean ± SD score for the perception of the VE and number of examinations in the active phase of labor was 62.9 ± 26.2 and 7.4 ± 2.44, respectively. Multiple linear regression analysis showed a significant relationship between perceived duration of examination (short, average [B = −1.03], long [B = 3.84]), feeling of comfort with the examiner (B = 2.73), and number of examiners (B = −0.81) with the mean scores of their perceptions ( P < .05). These 3 variables accounted for 8% of the changes in the women’s perceptions score of VE. Conclusion: The majority of participants in this study underwent excessive VEs during labor. If obstetrically safe, a reduction in the number of examinations during labor along with decreased duration based on women’s perceptions could improve women’s perceptions of VE overall. Additionally, should each VE be performed by the same clinician, women’s perceptions in relation to VEs may also improve.

Background: The research and advances in obstetrics are performed to overcome abnormal vaginal deliveries. The obstetrician's skill using digital vaginal examination (DVE) remains a personal skill with limitations. Objective: Assessment of the ability of intrapartum ultrasound capability to observe the progression of normal labor in the first stage compared to DVE accurately and objectively. Patients and methods: This prospective cohort study, was conducted on 62 singleton pregnancies in their 38-40 weeks of pregnancy at Obstetrics and Gynecology ultrasound unit and Maternity Hospital, during a period between 2018 to 2020. All cases received clinical examination including, general, abdominal, and obstetrical examination and ultrasonography examination including, transvaginal, transabdominal, and transperineal. Result: The transvaginal ultrasound evaluated the rate of cervical dilatation at the first stage of labor and the length of the cervix showed a statistically significant negative correlation and statistically significant positive correlation between time of labor progress at first and cervical length. There was statistically significantly higher mean cervical dilatation by DVE than US findings (4.58 & 4.29, respectively). Conclusion: Ultrasound usage possesses a potential role in predicting vaginal delivery success and helping the promotion of safe operative delivery. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to evaluate the possible effects of the various conditions especially bimanual examination on the adequacy of pap smear test. Study Design: Presented here is a prospective controlled clinical trial carried out at Ankara Atatürk Training and Research Hospital between November 2013 and March 2014. Total of 1771 patients seen at the gynecology outpatient clinic were included in the study. The technique described by the American Society of Cytopathology Criteria 2000 for the preparation of the specimen was followed. Updated Bethesda system 2014 was used for reporting the results. Results: Number of subjects in smear before examination group was 1194 and in the smear after examination group was 577. Two percent (n=36 subjects) of the cervicovaginal report was inadequate. When other clinical conditions were not taken into consideration, the likelihood ratio for inadequate smear in the smear after examination group was 2.64 compared to smear before examination group (p=0,004). Conclusions: In some conditions cervicovaginal smear sampling may be carried out after bimanual vaginal examination instead of missing the chance to screen the women. However, the patients have to be informed that cervicovaginal smear result might be inadequate so that a repeat test has to be carried out.

Sonographic approach for labour monitoring was introduced in order to improve the shortcomings of digital vaginal examination (DVE). This was a prospective study. We aimed to investigate the agreement between transperineal ultrasound (TPUS) measurements and DVE during first and second stages of labour. Patients in the first stage of labour were included. Cervical length (CL), cervical dilation (CD), cervical position (CP), foetal head descent (FHD) and foetal head rotation (FHR) were assessed by both DVE and TPUS. Agreement between two methods was examined. Eighty-five patients were included. One hundred and eighty-three paired TPUS and DVE assessments were performed. Satisfactory agreement between both methods was obtained regarding CL: systematic bias= −0.05 cm (95%CI, –0.13; 0.03), R = 0.7, p<.0001; CD: systematic bias = 0.07 cm (95%CI, –0.08 to 0.22), R = 0.93, p<.0001 and FHD: systematic bias = 0.83 cm (95%CI, 0.685–0.977), R = 0.55, p<.0001. There was a low correlation for the assessment of CP (kappa = 0.24) and FHR (kappa = 0.06). DVE was inefficient in determining FHR especially during latent phase with failure and error rates of 86% and 36%, respectively. A conceptual sonopartogram covering the hole childbirth process is presented based on reliable ultrasound measurements. What is already known on this subject? Digital vaginal examination (DVE) is used worldwide for labour monitoring. However, it is far from perfect. Some investigators have raised concerns about the value of the Bishop score because it is a subjective measure with great intra- and inter-observer variability, affected by a physician's clinical experience. Moreover, this method is intrusive, uncomfortable and may increase the risk of infection. The sonographic approach for labour monitoring was introduced in order to improve the shortcomings of DVE. Multiple studies focussed on the reliability of the sonographic method in assessing each parameter during labour. Hassan et al. were the first to determine whether it is feasible to perform assessment in the first stage of labour based only on US, and to describe a method of recording these observations: the 'sonopartogram'. What do the results of this study add? The outcomes concluded that sonographic approach was at least as accurate as the clinical examination. Moreover, a conceptual sonopartogram covering the hole childbirth process is presented based on reliable ultrasound measurements. What are the implications of these findings for clinical practice and/or further research? Clinical relevance of this sonopartogram should be evaluated in further studies. [ABSTRACT FROM AUTHOR]