Vaginal Examinations Flashcards
what are some indications that a VE may take place?
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)
why might a speculum examination be undertaken?
to query SROM
to query pre-term labour
contraindications of VEs:
no consent from woman
placenta praevia
unnecessary and won’t add to decision making progress
suspected pre-term labour
what are the general findings achieved from VEs?
cervical position cervical consistency cervical effacement cervical dilatation presence of membranes fetal descent fetal presentation application of presenting part
what are the three general ways cervical position is recorded?
anterior
mid
posterior
what are the three ways we would describe cervical consistency?
firm: hard and rubbery (tip of nose)
medium: compressible
soft: easily compressible, squidgy
cervical effacement involves…
the cervix thinning out
fetal descent is measured in a range from:
-5 to +5
application of the presenting part:
the amount of contact between the cervix and presenting part of fetus
described as either well applied or poorly applied
if the fetal head is poorly applied to the cervix, this may be associated with…
malposition and/or poor descent
what are the 4 different categories of fetal presentation found during a VE?
left occipito-anterior (LOA)
right occipito-posterior (ROP)
left mento-anterior (LMA)
left sacro-posterior (LSP)
what is the optimum fetal presentation that can be found in a VE?
left occipito-anterior (LOA)
fetal flexion:
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)
considerations to be thought about prior to VE:
parity full bowel previous trauma vaginismus FGM signs of infection (e.g. odour, temp)
anterior lip:
small section of cervix remaining that can be felt
between 9 and 10 cm
oedematous cervix:
swollen cervix
indications of complications with the labour progress
‘shrinking’ cervix:
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
multips os:
cervix hasn’t completely closed from first birth
cervix feels slightly open and stretchy if not even in labour yet
needed prior to VE:
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
when beginning a VE, external genitalia should be examined for:
lesions
previous scars
signs of STDS
(tap water may be used to clean vulva if needed)
when performing a VE it is important to think about facial expressions:
avoid looking worried, disappointed or disconnected
if a woman experiences a contraction during a VE…
stay still until it has passed then carry on
after a VE…
FHR should be auscultated
explanation to woman
offer change of sanitary towel, sheets
document findings
things to consider during speculum examination:
size position of woman (semi-recumbent) good lighting needed should be inserted in downward direction obtain swab if required
if SROM is suspected, women should lie down for ? before speculum examination?
30 mins
