Frequency of Digital Vaginal Examination and its Association with Chorioamnionitis and Early Neonatal Sepsis: A Prospective Cohort Study

BACKGROUND The association between the number of vaginal examination and maternal infection (Chorioamnionitis) and Neonatal sepsis is not clear. Several studies that have examined this association has come with varying results. The sequela of chorioamnionitis and neonatal sepsis are devastating. Determining the risk associated with them will have a significant reduction in maternal and neonatal morbidity and mortality. AIM This study aims to determine the association between high frequency of vagina examination and the maternal and neonatal infections. METHODOLOGY: This was a prospective cohort study conducted at the Kilimanjaro Christian Medical Centre (KCMC) labour ward. Low-risk pregnant women admitted during the study period were enrolled. Participants were categorized into two groups based on the number of vaginal examinations (VEs) performed during labour: ≤4 VEs and > 4 VEs . The incidence of chorioamnionitis and early-onset neonatal sepsis was assessed and compared between the two groups. Poisson regression with robust standard errors was used to estimate crude relative risks (CRR) and their corresponding 95% confidence intervals (CI) for the association between vaginal examination characteristics and the primary outcomes. Variables with P-value < 0.2, in the bivariate analysis were included in the multivariable model to estimate adjusted relative risks (ARR). Additional maternal and neonatal characteristics were considered to control for potential confounding in the final model. RESULTS Among 178 low-risk labouring women, higher vaginal examination frequency and examiner turnover were not significantly associated with chorioamnionitis after adjustment, though chorioamnionitis risk was elevated with ≥ 5 VEs (aRR = 1.96) and ≥ 4 examiners (aRR = 1.36). In contrast, being examined by four or more providers was significantly associated with early-onset neonatal sepsis (aRR = 3.41; 95% CI: 1.33–8.74), while undergoing more than four VEs showed a non-significant increased risk (aRR = 2.03; 95% CI: 0.80–5.15) for neonatal sepsis.