Used to the practice of vaginal examination during an ordinary consultation, women are not surprised that this examination is also performed during their pregnancy. A large part would even find it abnormal that it is not carried out. Until 1994, however, no study had been carried out on the usefulness and effectiveness of this technique. During the “Midwives Interviews” *, which took place in Paris in 2003, several speakers echoed the research carried out over the past ten years and which has led a certain number of midwives and obstetrician gynecologists to revise their results. practice.
What specialists criticize about this three-century-old examination, ס 'איז נישט not so much its harmfulness וואָס its uselessness. Performing a vaginal examination during each prenatal visit does not always allow, for so-called physiological pregnancies (that is to say, not presenting a particular problem), to detect a threat of premature birth, as was previously believed. now. As for its repeated uses during the work, they could be, if not replaced by other techniques considered more effective, at least more spaced out.
What alternative to vaginal examination?
לעצטע שטודיום ווייַזן אַז ultrasound of the cervix appears to be more effective than vaginal examination in screening for threats of preterm birth. However, not all medical personnel are familiar with this examination performed inside the vagina (we speak of endovaginal ultrasound). Its generalization is therefore not foreseen in the immediate future.
Systematic vaginal examination therefore no longer seems justified, especially sinceit often leads to a number of other unnecessary medical interventions. The midwife, the gynecologist or the general practitioner who detects, during this examination, a benign anomaly is always tempted to intervene in a preventive way although this is not necessarily necessary.
Take, for example, two women with very slight cervical dilation before the end of pregnancy, one having a pelvic exam with vaginal examination and the other not. The first is the risk of being prescribed a strict statements, at least for a while, while the other will continue his activities, at a pace normally slowed down by his condition, but no more. Both will likely see their pregnancies come to term safely. But in the end, the first is more likely to suffer from circulation problems due to her immobility than the second of giving birth prematurely.
In order to avoid over-medicalization of the monitoring of pregnant women, limitation of vaginal examination to relevant cases (which could be determined through more in-depth pre-interviews than they currently are) would be preferable, according to a vanguard of professionals. In reality, practices may change slowly.
* This conference took place within the framework of the Bichat Interviews, a series of annual conferences, very attended by professionals, taking stock of the latest developments and acquisitions of knowledge in each medical specialty.