A pelvic examination during pregnancy is a procedure where a healthcare provider assesses the health of the reproductive organs. This exam typically involves a visual inspection of the external genitalia and the use of a speculum to view the vagina and cervix. A manual, or bimanual, palpation is also performed to check the size and position of the internal organs. The purpose of this exam in prenatal care is to establish a baseline of health and screen for potential issues that could affect the pregnancy.
Initial Screening Pelvic Exam
The first pelvic exam usually takes place during the initial prenatal appointment, scheduled between six and twelve weeks. This early examination is conducted to confirm the pregnancy, check the cervix, and perform essential screening tests. The provider uses a speculum to visualize the cervix and collect cell samples for a Pap smear, if needed, to screen for abnormal cells.
During this visit, a swab is taken to test for common infections, including STIs (chlamydia and gonorrhea), bacterial vaginosis, or yeast infections. A bimanual exam follows, where the provider inserts two gloved fingers into the vagina while pressing on the lower abdomen. This manual palpation allows the provider to estimate the size and position of the uterus and ovaries, confirming gestational age and establishing a more accurate due date.
Pelvic Exams in Mid-Pregnancy
Routine pelvic exams are not standard during the second and early third trimesters (weeks 13 through 35). If symptoms are absent, the focus shifts to external monitoring, such as measuring fundal height and listening to fetal heart tones. Internal examinations are avoided unless a specific medical concern arises.
A pelvic exam may become necessary during mid-pregnancy if a patient reports unexplained vaginal bleeding, persistent discharge, or severe pelvic pain. It is also used to assess the cervix for early changes if signs suggest preterm labor, such such as pressure or cramping. In high-risk pregnancies, an exam may monitor the cervix or investigate an infection that could affect the developing fetus.
Late-Term Pelvic Exams
Pelvic exams become more common in the final weeks of pregnancy, usually starting around 36 or 37 weeks. These late-term examinations assess the state of the cervix in preparation for labor and delivery. The provider uses a manual check to determine three key measurements: dilation, effacement, and fetal station.
Dilation refers to how open the cervix is (measured in centimeters), while effacement is the thinning of the cervix (measured in percentage). Fetal station describes how far the baby’s head has descended into the pelvis relative to the ischial spines. Weekly checks are common but are considered elective prior to labor and do not reliably predict the exact timing of delivery.
The medical community has varying approaches regarding routine weekly checks before labor, with many providers leaving the decision up to the patient. These exams can be uncomfortable and carry a small chance of rupturing the membranes, which may lead to early induction. Patients have the option to decline these checks until they are in active labor or until a medical necessity arises, such as a planned induction.
A screening test is performed between 35 and 37 weeks to check for Group B Streptococcus (GBS) bacteria. This procedure involves swabbing the lower vagina and the rectum to collect a sample for laboratory culture. The GBS swab is a simple screening, not a cervical check, but is often done at the same appointment. If the test is positive, the patient receives prophylactic antibiotics during labor to prevent the bacteria from being transmitted to the newborn.