Vaginal examinations in pregnancy

Dr Crippen has been practising medicine for long enough to know that few medical systems have a monopoly of wisdom. Different conditions have different treatments in different countries.

I saw an eight year old Russian boy with tonsillitis last week. His mother, a technical translator originally from Moscow, said she was not keen on paracetamol or ibuprofen but preferred to treat him with camomile gargles. She says it works. I have not come across this before, but if that is what the Russians do, I am not going to argue.

Later on in the morning I saw a lady who was 36 weeks pregnant. She had come for a routine ante-natal check. She was English, but had been living in Germany for the last three years. She was now returning home to be close to her parents and to have her first child in her own country.

I asked her about her ante-natal care in Germany. She said it was excellent, but not at all what she had expected. The schedule, in terms of timing, was much the same as in the UK. Monthly visits to the obstetrician until 32 weeks, then fortnightly then, from 36 weeks, weekly. But the content was different. At each and every ante-natal appointment, the German obstetrician had, as a matter of routine, performed a vaginal examination and a trans-vaginal ultrasound. This lady had had no less then seven such examinations during the progress of an entirely normal pregnancy.

Each visit to the obstetrician had cost her €180.

I advised her that I did not propose to do a routine vaginal examination as I could see no purpose. She was happy with that.

In the UK, the average woman going through pregnancy would have no routine vaginal examinations. The first one would be in the early stages of labour to check cervical effacement and dilatation.

This is not a minor difference. It is huge. I am sure that the standard of medical care in Germany is excellent. I do know that they have a lot of doctors there and, I must say, one wonders if they are hungry for work. Even allowing for that, this is still very different management. I discussed it with Mrs Crippen, herself a doctor, and the mother of four children. After a little mental arithmetic, she felt quite faint!

Dr Crippen sits back and worries. He always thinks of the Germans as efficient and thorough. Have we got it wrong in the UK? There are, of course, indications for pelvic examinations in pregnancy, but in the UK these are predicated by problems and are not routine.

The practices in the UK and Germany cannot both be right. Dr Crippen doubts that pelvic examinations should be performed as a routine during ante-natal care. And after much thought, he rather doubts that there is a middle ground.


Illustration from Almeida Cartoons