Clinician perspectives on speculum exams in PPROM: a survey study

The American College of Obstetricians and Gynecologists recommends speculum exams rather than digital exams for cervical evaluation in preterm prelabor rupture of membranes (PPROM). However, making management decisions based on speculum exams has challenges. This study aims to investigate OB/GYN clinicians' self-reported adherence to and comfort with these recommendations.

We conducted a web-based survey distributed via email to labor and delivery clinicians at nine hospitals in 2024. The survey inquired about respondents' management of a hypothetical patient admitted with stable PPROM who now requires cervical evaluation due to symptoms like contractions. We used descriptive statistics to compare practices across different hospital settings, provider types, and levels of training.

Sixty respondents completed the survey. Most respondents "always" (58%) or "often" (30%) attempt speculum exam before resorting to digital exam. However, 30% of respondents reported needing to perform a digital exam after a speculum exam more than half of the time, primarily due to inability to visualize the cervix or patient instability. When asked about their confidence in decisions made post-exams, 37% of respondents expressed high confidence after speculum exams, whereas 85% reported high confidence after digital exams. Respondents reported that they believe patients experience more discomfort with speculum exams.

This survey indicates that while providers attempt to follow recommendations for speculum exams in PPROM, they often find this exam type insufficient and resort to using both speculum and digital exams. Confidence in clinical decision making was cited as a significant barrier to adhering to the guidelines.