When You Do (And Don't) Need A Cervical Check

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pregnancy When You Do (And Don't) Need A Cervical Check

The end of pregnancy is UNCOMFORTABLE. Do you need to add a cervical check to that mix? One expert weighs in.

4 min read

By Stephanie McNally, MD, OB/GYN, Northwell Health • Patricia Scanlon, Writer

Anybody who’s been pregnant and had a cervical exam late in their pregnancy knows that the procedure is far from pleasant. This exam—during which a provider inserts a gloved hand into the vagina to check the cervix—can be especially uncomfortable in the final weeks of pregnancy because there’s increased blood flow and swelling in the vagina.

So why do OB/GYNs do cervical exams in the final weeks of pregnancy? If you ask many physicians, the answer you may hear is, “It’s just what we do.” It’s almost like it’s part of the culture. But in recent years, many of us who care for pregnant patients have reexamined this practice, and for good reason.

The truth is that while there are situations where a cervical exam late in pregnancy can be useful or even necessary, in many cases there’s no real good reason to do it.

The rationale for routinely doing cervical exams in the final weeks of pregnancy has been to check for changes in the cervix that occur in the early stages of labor. These include dilation (opening of the cervix) and effacement (thinning out of the cervix). But what we’ve learned is that these signs alone are not always a good indicator of how close someone is to going into labor. One patient could have a closed cervix today and deliver tomorrow, while another patient might be walking around at 3 centimeters dilated for three weeks.

Early in a patient’s pregnancy, sometimes as early as their first appointment, I will often do a pelvic exam because I want to assess the shape of their pelvis. This is important because if their pelvis is very narrow, they may have trouble having a vaginal delivery, especially if the baby is very big.

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My approach to cervical exams in the final weeks of pregnancy is that the exam should only be done if it would change the way I manage the patient. For instance, if I have a patient who’s having a planned C-section and they’re not having any symptoms, then a cervical exam is unnecessary.

So, when is it appropriate to do a cervical exam in the final weeks of pregnancy? These are the most common scenarios:

• There are signs a patient might be in labor. If someone is having symptoms associated with labor, including pain, bleeding, or a clear or pink sticky discharge (mucus plug), then that definitely warrants a cervical check to see how dilated and effaced the cervix is. Having that information is vital to planning for the baby’s safe delivery.
• The patient needs to be induced for a medical reason. When I see a patient who needs to be induced for a medical reason—such as high blood pressure, or growth problems with the baby—then I want to know where things stand with their cervix before they go to the hospital so I can manage and plan accordingly.
• The patient chooses to be induced. Many patients want to be induced even when there’s no medical reason to do so. With these elective inductions, we look at something called the Bishop score, which covers five different aspects, including dilation and effacement, as well as the station of the presenting fetal part (which should be the head), the “softness” of the cervical tissue, and its position in the vaginal canal.

Knowing the Bishop score is important because I want to know that their body really is ready for an induction. If you’re starting to induce somebody who's not as far along as they should be, that potentially increases the length of delivery and it could mean they end up needing a C-section. So in this case especially, doing that cervical check can ensure that a patient will have a successful elective induction.

Some patients worry about having a cervical exam late in pregnancy because they’ve heard it may cause their water to break prematurely, but this is very unlikely. Even when we sweep a patient’s membranes (a procedure we do after the cervix has begun to open, which involves using a gloved finger to gently sweep the membrane that's attached to the cervix to release hormones that could potentially incite contractions that then may lead to labor), that alone won’t break a patient’s water.

Bottom line: If you’re in your final weeks of pregnancy, aren’t having any symptoms of labor, and aren’t being induced—whether for medical reasons or otherwise—then there’s no reason to do a cervical check, and you have every right to decline that exam.

Next Steps and Useful Resources

• What to eat—and not eat—during pregnancy.
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• This flat orange soda helps diagnose gestational diabetes.

February 28th, 2022 Tags: pregnancy women's health screening

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