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Less frequent versus more frequent cervical examinations in labor: A systematic review and meta-analysis
Alessandro Petrecca1, Benedetta Bina2, Chiara Tersigni3
1Catholic University of the Sacred Heart, Department of Woman and Child Health and Public Health Sciences, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy.
Background:
Digital cervical examinations are central to intrapartum care, yet their optimal frequency remains uncertain and is largely based on consensus rather than high-quality evidence.
Objectives:
To compare less frequent versus more frequent cervical examinations during labor in terms of obstetrical, maternal and neonatal outcomes.
Search Strategy:
We searched Medline, Cochrane Library, EMBASE, PubMed Central, Scopus and ClinicalTrials.gov from inception to August 2025, without language or geographic restrictions. The review was registered in PROSPERO (CRD420251033729).
Selection Criteria:
Randomized controlled trials comparing different frequencies of cervical examinations in term singleton pregnancies during labor were included.
Data Collection And Analysis:
Two reviewers independently performed study selection, data extraction and risk of bias assessment. The primary outcome was time from randomization to delivery (reported as either duration of labor, time from induction to delivery, time from amniotomy to delivery or time from early labor to birth interval). Secondary outcomes included labor duration, mode of delivery, maternal and neonatal outcomes. Effect estimates were pooled as relative risks or mean differences with 95% confidence intervals.
Main Results:
Five RCTs including 982 women were analyzed. Less frequent examinations showed no significant difference in time from randomization to delivery compared with more frequent schedules (11.1 vs 9.93 h; p = 0.78). No differences were observed in labor duration, mode of delivery, maternal complications or neonatal outcomes. In a post-hoc exploratory subgroup analysis restricted to trials comparing 8-hour versus 4-hour examination intervals (n = 668), less frequent examinations were associated with fewer operative vaginal deliveries (RR 0.50, 95% CI 0.26-0.97).
Conclusions:
Less frequent cervical examinations during labor were not associated with significant differences in maternal, neonatal, or obstetrical outcomes compared with more frequent assessments. However, the available evidence remains insufficient to exclude clinically meaningful differences between examination schedules because of substantial clinical heterogeneity, modest sample sizes, and low event rates. Larger, high-quality randomized controlled trials are needed before definitive conclusions can be drawn.
