A pelvic exam during pregnancy is an internal assessment of the vagina, cervix, and uterus performed by a healthcare provider. This procedure helps gather information about the health of the reproductive organs and the progress of the pregnancy. The frequency of these examinations changes significantly depending on the stage of gestation. Standard prenatal care typically includes one initial exam, a long period without routine checks, and then potential exams toward the end of the third trimester.
The Initial Pelvic Exam: Screening and Baseline Assessment
The first prenatal visit, typically scheduled around eight to twelve weeks of gestation, almost always includes a comprehensive pelvic examination. This initial assessment establishes a baseline for the entire pregnancy and provides an opportunity for essential screenings. During this exam, the provider manually assesses the size and position of the uterus to confirm the gestational age and estimated due date.
The initial exam is often bundled with necessary laboratory work and cultures. A Pap smear may be performed if the patient is due for one. Swabs are usually taken to screen for sexually transmitted infections like chlamydia and gonorrhea. The provider also visually inspects the vulva and vagina for any signs of infection, such as yeast or bacterial vaginosis.
Routine Visits: The Absence of Mid-Pregnancy Exams
After the initial comprehensive check, pelvic exams are generally not a routine part of mid-pregnancy prenatal visits, which span until approximately 36 weeks. This period is characterized by external monitoring rather than internal assessments. Routine appointments during this time focus on checking maternal health through vital signs and weight gain.
Instead of an internal exam, the provider monitors fetal growth by measuring the fundal height, which is the distance from the pubic bone to the top of the uterus. Ultrasound scans also provide detailed information about the baby’s growth and position. For women without symptoms or complications, routine pelvic examinations offer little clinical value during this period and are therefore avoided.
Late-Term Exams and Monitoring Cervical Change
Pelvic exams become relevant again starting around 36 weeks of gestation, when appointments often shift to a weekly schedule. These exams, often called cervical checks, are performed to assess the readiness of the cervix for labor. The provider manually checks for three specific changes: effacement, dilation, and fetal station.
Effacement refers to the thinning of the cervix, measured in percentages. Dilation is the opening of the cervix, measured in centimeters. Fetal station indicates how far the baby’s head has descended into the pelvis.
While many providers offer weekly checks from 36 weeks until delivery, the practice is subject to debate. There is limited evidence showing that routine checks predict when labor will actually begin. These late-term exams are considered optional and are not mandatory for a healthy pregnancy.
Patients maintain the right to decline these internal exams, especially if they are not facing an induction or other medical indication. Frequent cervical checks in late pregnancy may slightly increase the risk of introducing infection or prematurely rupturing the membranes. The most common time for an internal exam during this period is around 36 weeks to collect a swab for Group B Streptococcus (GBS) screening.
Specific Medical Reasons for Additional Exams
While most of the pregnancy proceeds without internal checks, a pelvic exam may be necessary at any stage if specific medical symptoms or concerns arise. These exams are diagnostic tools used to investigate a problem rather than routine screening. Unexplained vaginal bleeding, for example, requires an internal assessment to determine the source and rule out complications like placental issues or cervical changes.
Signs of infection, such as abnormal vaginal discharge, pain, or itching, can also prompt a pelvic exam to collect samples for culture and diagnosis. If a patient reports symptoms suggesting preterm labor, an internal exam may be performed to assess the length and dilation of the cervix. These non-routine examinations are performed only when clinically indicated to rule out serious pathology.