Vaginal Examination

Question 1

Explain the process of the vaginal examination

Answer 1

1. Carry out abdominal palpations incl fetal heart to determine the lie and the presenting part of the fetus
2. Remove underwear and cover bottom half with blanket/sheet to maintain her privacy
3. Apply ppe on to reduce time woman is in position
4. Position woman: recumbent position, knees bent, ankles together and place sheet underneath her bottom. Ask for consent again. Document if alternative position is used
5. Lubricate forefingers of dominant hand
6. Inspect general genital region including labia, clitoris, discharge - consider infection/scars/trauma/cysts/inflamation
7. With non-dominant hand part labia and observe condition
8. When mother is ready, gently place two fingers of examining hand into vagina in a downwards and backward direction along the anterior vagina wall - ensure thumb does not contact the anus or clitoris
9. Locate the cervix and determine the: position, degree of effacement, dilation, application of presenting part
10. Move the fingers through the cervical os to ascertain the presence of: fore waters/membranes, presentation, position 12 o’clock at the top under symphysis pubis and 6 o’clock at the sacrum
11. Degree of flexion
12. Level of presenting part
13. Exclude cord or placenta
14. Be aware of passage - pelvis shape/structures
15. Keep still if contractions come
16. Withdraw fingers gently, Remove gloves, Ausculate the fetal heart rate remember post clinical actions and discussion
17. Wash hands

Question 2

Explain what you would do prior to the vaginal examination

Answer 2

1. Wash hands
2. Introduce yourself&role. Confirm name and dob. Explain examination and gain consent
3. Ask if there is any concerns
4. Ensure privacy and dignity is maintained
5. Gather equipment: clean and sterile gloves, apron, lubricant, disposable sheet and clean trolley/surface
6. Ask her to empty her bladder