Vaginal examination and Urinary urethral catheterisation Flashcards
What are the reasons for undertaking a VE during labour?
- Assess progress (dilatation, effacement, position, station, membranes)
- Exclude cord prolapse
- ARM
- FSE placement
- Confirm onset of second stage
- Before an epidural
What needs to be discussed prior to the VE to gain informed consent?
- Reason for doing it
- Tell her she can say stop at any point
- What you will be assessing
- How it is performed
- Any risks and the benefits
- Ensure to document verbal consent
What are the contraindications for performing a VE?
- no consent
- active bleeding
- placenta previa
- suspected pre-term labour
- PROM
What does a hot, dry vagina indicate?
Dehydration, infection or obstructed labour
What should you tell the woman to do prior to a VE?
Empty her bladder
A head at -4 station is above or below spines?
Above
What is zero station?
When the presenting part is at the ischial spines.
What should the midwife do prior to a VE?
An abdominal palpation to determine lie, presentation, position and degree of engagement.
FHR
What should be done after a VE?
Ensure woman is comfortable and auscultate FHR. Document findings.
When is a bishop score used?
To determine if cervix is favourable for a ARM.
What are the indications for an amniotomy?
- IOL
- Augmentation of labour
- FSE application
- Assess liquor colour
- Maternal request
- Prior to the birth of second twin
What are the contraindications for an amniotomy?
- No consent
- High presenting part
- Preterm labour
- Vaginal infection
- Maternal HIV+
- Caution with polyhydramnios or malposition, malpresentation
- Placenta praevia
- vasa preaveia
How does childbearing affect micturition?
As the baby develops in utero the bladder becomes flattened which can result in frequent urination and incontinence.
The pelvic nerves can become damaged, reducing sensation.
How can the midwife promote good urinary care?
Encourage a good fluid intake
Limit fluid intake late at night.
What can be done to prevent infection from catheterisation?
- Removing it when it is no longer needed.
- Care of catheter and drainage system
- Specimens obtained aseptically
- Drainage bag keep lower than bladder to prevent backflow.
- A holder is used to keep bag off the floor and prevent pulling on the catheter.
- Bag emptied when 2/3 full
- Prevent kinking or occlusion
- Observe for signs of UTI
- Maintain personal hygiene
- 2L a day fluid intake.
