Vaginal Examinations

Question 1

what are some indications that a VE may take place?

Answer 1

assess progress in labour
confirm onset of labour
stretch and sweep
assess fetal position
perform ARM
apply FSE
suspected fetal compromise (e.g. examine umbilical cord position)

Question 2

why might a speculum examination be undertaken?

Answer 2

to query SROM

to query pre-term labour

Question 3

contraindications of VEs:

Answer 3

no consent from woman
placenta praevia
unnecessary and won’t add to decision making progress
suspected pre-term labour

Question 4

what are the general findings achieved from VEs?

Answer 4

cervical position
cervical consistency
cervical effacement
cervical dilatation
presence of membranes
fetal descent
fetal presentation
application of presenting part

Question 5

what are the three general ways cervical position is recorded?

Answer 5

anterior
mid
posterior

Question 6

what are the three ways we would describe cervical consistency?

Answer 6

firm: hard and rubbery (tip of nose)
medium: compressible
soft: easily compressible, squidgy

Question 7

cervical effacement involves…

Answer 7

the cervix thinning out

Question 8

fetal descent is measured in a range from:

Answer 8

-5 to +5

Question 9

application of the presenting part:

Answer 9

the amount of contact between the cervix and presenting part of fetus

described as either well applied or poorly applied

Question 10

if the fetal head is poorly applied to the cervix, this may be associated with…

Answer 10

malposition and/or poor descent

Question 11

what are the 4 different categories of fetal presentation found during a VE?

Answer 11

left occipito-anterior (LOA)
right occipito-posterior (ROP)
left mento-anterior (LMA)
left sacro-posterior (LSP)

Question 12

what is the optimum fetal presentation that can be found in a VE?

Answer 12

left occipito-anterior (LOA)

Question 13

fetal flexion:

Answer 13

how well fetal head is flexed
chin should be tucked into chest
assessed by position of the sutures and fontanelles
(if deflexed, anterior and posterior fontanelles may be palpable)

Question 14

considerations to be thought about prior to VE:

Answer 14

parity
full bowel
previous trauma
vaginismus
FGM
signs of infection (e.g. odour, temp)

Question 15

anterior lip:

Answer 15

small section of cervix remaining that can be felt

between 9 and 10 cm

Question 16

oedematous cervix:

Answer 16

swollen cervix

indications of complications with the labour progress

Question 17

‘shrinking’ cervix:

Answer 17

well-applied fetal head may make cervix appear more dilated

(will most likely occur when performing VE during contraction)

may also occur just due to different practitioners performing on same woman

Question 18

multips os:

Answer 18

cervix hasn’t completely closed from first birth

cervix feels slightly open and stretchy if not even in labour yet

Question 19

needed prior to VE:

Answer 19

the need for it to be performed
consent from woman and offer of chaperone given
known obstetric history
empty bladder
hand hygiene
abdominal palpation and FHR auscultation

Question 20

when beginning a VE, external genitalia should be examined for:

Answer 20

lesions
previous scars
signs of STDS

(tap water may be used to clean vulva if needed)

Question 21

when performing a VE it is important to think about facial expressions:

Answer 21

avoid looking worried, disappointed or disconnected

Question 22

if a woman experiences a contraction during a VE…

Answer 22

stay still until it has passed then carry on

Question 23

after a VE…

Answer 23

FHR should be auscultated
explanation to woman
offer change of sanitary towel, sheets
document findings

Question 24

things to consider during speculum examination:

Answer 24

size
position of woman (semi-recumbent)
good lighting needed
should be inserted in downward direction
obtain swab if required

Question 25

if SROM is suspected, women should lie down for ? before speculum examination?

Answer 25

30 mins