Vaginal Examination (W/S 7) Flashcards
What does a VE involve?
An examination of the external genitalia, vagina, cervix
and presenting part of the fetus.
What should always precede a VE?
Abdominal palpation (and consent!)
What are possible indications for a VE? (5)
- confirm commencement of labour
- assess the progress of labour
- confirm the presenting part, particularly if there is any
doubt - perform any necessary procedures, such as artificial
rupture of the membranes or application of a fetal scalp
electrode - Prior to administering analgesia
What is involved in preparing for a VE? (6)
- explanation to woman, consent gained
- bladder empty.
- wedge left lateral
- perform abdominal examination
- ensure privacy, warmth and comfort
- equipment – gloves, lubricant, Pinard or doptone
Vulva - what are you looking for prior to the VE? (3)
Discharge – mucous, blood, liquor
Varicosities, lesions, excoriation, oedema
Scarring from previous trauma
What is recommended to say to the woman prior to beginning the VE?
“Tell me when you’re ready.”
Vagina - how might it feel when conducting the VE?
- Tenseness or tightness
- Warm and moist or hot and dry
- Presence of cystocele (anterior vaginal prolapse) or rectocele (posterior vaginal prolapse)
- Presence of full rectum
Cervix - what to note during a VE?
PEDAC
- Position: midline, anterior, lateral, posterior
- Consistency: soft or hard, thick or thin, oedematous, rigid
- Effacement: describing length in centimetres is less subjective than using a percentage
- Dilatation: in centimetres
- Application: well applied or loosely applied
Membranes - what to note during a VE?
- Intact: bulging or tight
- Ruptured: describe liquor, exclude presence of cord
What to take note of during a VE for assessing progress?
- Descent of presenting part (station)
- Effacement of cervix
- Dilatation of cervix
- Application of pp to cervix
- Moulding or caput
- Membranes intact or ruptured
What needs to occur after a VE? (4)
- Auscultate fetal heart
- Make woman comfortable
- Discuss findings with woman
- Document findings and report any abnormalities
What is meant by station? What are the stations?
The station of presenting part in relation to ischial spines.
-4
-3
-2
-1
0 - at ischial spines
+1
+2
+3
What can be used to rupture membranes?
Amnihook
Amnicot
When rupturing membranes, when should an Obstetrician be present or conducting?
If head is not well applied to the cervix.
How do you determine position during a VE?
Relate the landmarks of the fetal skull to landmarks of the pelvis.
