vaginal examinations

Question 1

why are vaginal examinations performed

Answer 1

• Confirm onset of labour
  
  • Diagnose presentation
  • Prior to analgesia administration
  • Perform ARM
  • assess progress in labour
  • Assess condition of cervix
  • Concerns for Fetal well being
  • Apply FSE
  • To administer remove medication
  • Decision around MOB
  • Emergency
  • Perform membrane sweep

Question 2

what is assessed in a vaginal examination

Answer 2

• Vulva
  
  • Vagina
  • Cervix
  • Fetus
    Other

Question 3

vulva and vagina

Answer 3

• Varicosities
  
  • Infection `
  • Oedema
  • Scars
    Warts

Question 4

cervix

Answer 4

you would check for
Position - posterior , mid and anterior
Consistency - firm , softening and soft
Application - well and loose

Question 5

effacement

Answer 5

Long
Effaced
Fully effaced
Partially effaced
Oedematous

Question 6

Cetus presentation

Answer 6

• Breech
  
  • Face
  • Brow
  • Vertex
    Shoulder

Question 7

fetus attitude

Answer 7

• Flexed
  
  • Deflexed
  • Extended
  • Hyper extended

Question 8

position

Answer 8

Position
Relationship of denominator to the 8 key points of the pevic brim

Occiput
Mentum
Sacrum

Question 9

moulding

Answer 9

Moulding
0+
1+
2+
3+

Question 10

caput

Answer 10

Caput
0+
1+
2+
3+

Question 11

membranes

Answer 11

• Present
  
  • Absent
  • Well applied
    Bulging

Question 12

cord prolapse

Answer 12

cord protruding through the cervix - membranes absent

Question 13

When are vaginal examination contraindicated

Answer 13

• No consent
  
  • Placenta praevia
  • Active bleeding
  • Pre labour rupture of membranes
  • Pre term pre labour rupture of membranes
  • Suspected pre term labour
  • Obvious signs of placental abruption

Question 14

how do you prepare for a ve

Answer 14

• Check notes
  
  • Empty bladder
  • Ensure informed consent , privacy , dignity and comfort
  • Gather equipment - consider if ve pack is needed
  • Abdominal palpation and auscultation
  • Semi recumbent position
  • As relaxed as possible
    Done ppe and prepare sterile gloves

Question 15

what is the process of a vaginal examination

Answer 15

• If using VE packs wipe vulva front to back
  
  • Lubricate first 2 gloved fingers of dominant hand
  • Part labia & insert 2 fingers (downwards and backwards)
  • Ensure thumb doesn’t come into contact with clitoris or anus
  • Consider your facial expressions
  • Feel for cervix
  • Remove fingers gently
  • Remove gloves , removed soiled pad , cover with sheet
    Auscultate Fetal heart

Question 16

what are the findings of vaginal examinations

Answer 16

• Correlate findings of abdominal palpation & vaginal examination
  
  • Explain findings and possible impact on birth plan
  • Provide reassurance where possible
  • Document - justification , consent , procedure , findings , discussions and actions
  • Further plan
    Escalate accordingly

Question 17

what are the risks involved

Answer 17

• Invasive and intimate
  
  • Painful
  • Measurements subjective
  • Inconsistency between practitioners
  • Accidental rupture of membranes
  • May disrupt concentration
  • May require position change
    May increasing feelings of vulnerability