Geschreven door Marlous van der Waal
Gepubliceerd op 9 maart 2023
Tijdens de baring voeren zorgverleners regelmatig een vaginaal inwendig onderzoek uit. Soms wordt het inwendig onderzoek ook aangeboden tijdens de zwangerschap. De zorgverlener voelt met twee vingers naar onder andere de baarmoedermond en eventuele ontsluiting. Het inwendig onderzoek noemen we ook wel vaginaal onderzoek of vaginaal toucher. Meestal dient het inwendig onderzoek om de voortgang van de baring in de gaten te houden, maar het kan ook informatie geven over mogelijke complicaties.
Wat is het inwendig onderzoek precies? Is het routinematig uitvoeren van een inwendig onderzoek zinvol? Wat zijn eventuele nadelen? En zijn er alternatieven? Deze en meer vragen beantwoorden we in dit artikel.
Abalos, E., Chamillard, M., Díaz, V., Pasquale, J., & Souza, J. P. (2020). Progression of the first stage of spontaneous labour. Best practice & research. Clinical obstetrics & gynaecology, 67, 19–32. https://doi.org/10.1016/j.bpobgyn.2020.03.001
Abukhalil IH, Kilby MD, Aiken J, Persad V, Sinclair D, Johanson RB, et al. (1996). Can the frequency of vaginal examinations influence the duration of labour? A prospective randomised study. Journal of Obstetrics and Gynaecology;16:22‐5. https://doi.org/10.3109/01443619609028375
Borelli S.E., Locatelli A., Antonella N. (2013). Early pushing urge in labour and midwifery practice: A prospective observational study at an Italian maternity hospital. Mifwifery. 29: 871-875 doi: http://dx.doi.org/10.1016/j.midw.2012.09.010
Brown HC, Paranjothy S, Dowswell T, Thomas J. (2008) Package of care for active management in labour for reducing caesarean section rates in low-risk women. Cochrane Database Syst Rev.; (4): CD004907. https://doi.org/10.1002/14651858.CD004907.pub2.
Buchmann, E. J., & Libhaber, E. (2007). Accuracy of cervical assessment in the active phase of labour. BJOG : an international journal of obstetrics and gynaecology, 114(7), 833–837. https://doi.org/10.1111/j.1471-0528.2007.01386.x
Cheyne, H. (2008). Effects of algorithm for diagnosis of active labour: cluster randomised trial. The BMJ. https://www.bmj.com/content/337/bmj.a2396.full
Dahlen, H., Downe, S., Duff, M. & Gyte, G. (2013). Vaginal Examination During Labour: Routine Examination of Routine Intervention? International Journal of Childbirth Vol 3 Issue 3 , DOI: 10.1891/2156-5287.3.3.142. https://connect.springerpub.com/content/sgrijc/3/3/142
Dixon, L., Foureur, M. (2010). The vaginal examination during labour: Is it benefit or harm? New Zealand College of Midwifes. Practise issue. http://hdl.handle.net/10453/13828
Dixon, L., Skinner, J. & Foureur, M. (2013). The emotional journey of labour-women’s perspectives of the experience of labour moving towards birth. Midwifery . 2014 Mar;30(3):371-7. doi: 10.1016/j.midw.2013.03.009.
Downe S, Young C, Moran VH (2008). The early pushing urge: practice and discourse. In: Downe S, editor. Normal childbirth: evidence and debate. 2nd Ed ed. Edinburgh: Churchill Livingstone;. p. 128-148.
Ferrazzi, E., Milani, S., Cirillo, F., Livio, S., Piola, C., Brusati, V., & Paganelli, A. (2015). Progression of cervical dilatation in normal human labor is unpredictable. Acta obstetricia et gynecologica Scandinavica, 94(10), 1136–1144. https://doi.org/10.1111/aogs.12719
Finucane, E. M., Murphy, D. J., Biesty, L. M., Gyte, G. M., Cotter, A. M., Ryan, E. M., Boulvain, M., & Devane, D. (2020). Membrane sweeping for induction of labour. The Cochrane database of systematic reviews, 2(2), CD000451. https://doi.org/10.1002/14651858.CD000451.pub3
Lewin D, Fearon B, Hemmings V, Johnson G. (2005). Women's experiences of vaginal examinations in labour. Midwifery; 21:267‐77. https://doi.org/10.1016/j.midw.2004.10.003
Moncrieff, G., Gyte, G.M.L., Dahlen, H.G., Thomson, G., Singata-Madliki, M., Clegg, A., Downe, S. (2022) Routine vaginal examinations compared to other methods for assessing progress of labour to improve outcomes for women and babies at term. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD010088. https://doi.org/10.1002/14651858.CD010088.pub3.
Nederlandse Vereniging voor Obstetrie en Gynaecologie (2013). NVOG Richtlijn Spontane vaginale baring. https://www.nvog.nl/wp-content/uploads/2018/02/Spontane-vaginale-baring-2.0-14-11-2013.pdf
Koninklijke Nederlandse Organisatie van Verloskundigen (2006). KNOV-standaard Niet vorderende ontsluiting. https://assets.knov.nl/p/557056/none/PDF%20richtlijnen,%20standaarden,%20standpunten/KNOV-Standaard%20Niet%20vorderende%20ontsluiting.pdf
LVOG (2021). Richtlijn baring in AAV. de Miranda, E., van der Bom, J. G., Bonsel, G. J., Bleker, O. P., & Rosendaal, F. R. (2006). Membrane sweeping and prevention of post-term pregnancy in low-risk pregnancies: a randomised controlled trial. BJOG : an international journal of obstetrics and gynaecology, 113(4), 402-408. https://doi.org/10.1111/j.1471-0528.2006.00870.x
Murphy K, Grieg V, Garcia J, Grant AM. (1986). Maternal considerations in the use of pelvic examinations in labour. Midwifery 1986;2:93-7.
NICE (2014). Guideline CG190: Intrapartum care for healthy women and babies.
Papoutsis, D., Antonakou, A., Gornall, A., & Tzavara, C. (2023). The purple line and its association with cervical dilatation in labour: A systematic review and meta-analysis. European Journal Of Obstetrics & Gynecology And Reproductive Biology, 289, 91–99. https://doi.org/10.1016/j.ejogrb.2023.08.383
Phelps JY, Higby K, Smyth MH, Ward JA, Arredond F, Mayer AR. (1995). Accuracy and intraobserver variability of simulated cervical dilation measurements. American Journal of Obstetrics and Gynecology;173:942‐5. https://doi.org/10.1016/0002-9378(95)90371-2
Pintucci, A., Meregalli, V., Colombo, P., & Fiorilli, A. (2014). Premature rupture of membranes at term in low risk women: how long should we wait in the “latent phase”. Journal of perinatal medicine, 42(2), 189–196. https://doi.org/10.1515/jpm-2013-0017
Reed, R (2019a). Pushing: leave it to the experts. MidwifeThinking. Geraadpleegd op 24 oktober 2022, van https://midwifethinking.com/2015/05/02/vaginal-examinations-a-symptom-of-a-cervix-centric-birth-culture/
Reed, R (2019b). Vaginal examinations: a symptom of a cervical-centric birth culture. MidwifeThinking. Geraadpleegd op 24 oktober 2022, van
Reed, R, Barnes, M, Rowe, J, (2016) Women’s Experience of Birth: Childbirth as a Rite of Passage. International Journal of Childbirth, vol. 6, no. 1, pp.46-56. https://doi.org/10.1891/2156-5287.6.1.46
Reed, R. (2021). Reclaiming Childbirth As a Rite of Passage: Weaving Ancient Wisdom with Modern Knowledge. Word Witch
Sadler LC, Davison T, McCowan LM. (2000) A randomised controlled trial and meta-analysis of active management of labour. BJOG. 107(7): 909-15. https://doi.org/10.1111/j.1471-0528.2000.tb11091.x
Seaward, P. G., Hannah, M. E., Myhr, T. L., Farine, D., Ohlsson, A., Wang, E. E., Haque, K., Weston, J. A., Hewson, S. A., Ohel, G., & Hodnett, E. D. (1997). International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. American journal of obstetrics and gynecology, 177(5), 1024–1029. https://doi.org/10.1016/s0002-9378(97)70007-3 Seval (2016), Effects of digital vaginal examination during labor on pain and anxiety: a andomized controlled trial, Published data only, clinicaltrials.gov/show/NCT02599610
Shepherd, A., Cheyne, H., Kennedy, S., McIntosh, C., Styles, M., & Niven, C. (2010). The purple line as a measure of labour progress: a longitudinal study. BMC pregnancy and childbirth, 10, 54. https://doi.org/10.1186/1471-2393-10-54
Wickham, S. (2021). In Your Own Time: How Western Medicine Controls the Start of Labour and why this Needs to Stop. Birthmoon Creations.
Wickham, S. (2022). The Rhombus of Michaelis. Geraadpleegd op 24 oktober 2022, van https://www.sarawickham.com/articles-2/the-rhombus-of-michaelis/ World Health Organizatino (2018). WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf
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