Vaginal Examinations Flashcards
Give some psychological and emotional issues surrounding VE
- Can be painful, distressing, embarrassing, invasive
- Issues of sexual intimacy, vulnerability, sexual abuse, physical abuse, rape
- Give women opportunity to disclose issues when fully clothed
- Examination should not proceed if it causes distress
What is vaginismus?
- Fear of penetration
- Relates to past experiences or of unknown origin
- May need referral to psychosexual counselling
Give some consent issues surrounding VE
- Should be verbal and informed
- Without coercion
- Should be gained for each separate procedure
- Without consent, a VE is assault
- Consent can be withdrawn at any stage
- Must be obtained prior to procedures under anaesthetic
What is coercion?
Persuasion
Who should special considerations be made for when gaining consent?
- <16s
- Learning difficulties
- Mental illness
- Cultural, ethnic and religious diversities
Give some reasons for a VE to be carried out
- To confirm onset of labour
- Determine presentation, attitude and position
- Assess progress/delay in labour
- To apply Foetal Scalp Electrode/ FBS
- Screening/ diagnostic purposes
- To assess trauma post-delivery
- Maternal request
What are some contra-indications for VE?
- Vaginal bleeding
- Placenta praevia
- Preterm labour
- Preterm rupture of membranes
- Speculum
- No consent given
What is a speculum?
- Holds vagina open to shine torch down so VE can be done visually
- Only for specified circumstances such as pre-labour rupture of membranes
What should be considered prior to the VE?
- Can you document a clear reason for performing a VE?
- Is there another non-invasive way to acquire info?
- Are you following policies and guidelines?
Give some alternative approaches to a VE
- Listen to woman
- Watch for behaviour changes
- Look for changes in FHR
- External signs (e.g. purple line, labial gaping, anal dilation)
How should you prepare for a VE?
- Establish justification
- Obtain consent
- Respect maternal wishes
- Consider woman’s comfort, dignity and privacy
- Consider analgesia
- Consider cultural, religious and ethical needs
- Palpate abdomen and auscultate FHR
- Position appropriately
- Consider allergies
- Consider ANTT
- Prepare equipment
What equipment is required?
- Gloves
- Adequate lighting
- Speculum
- Swabs
- Gauze
- Water
- Sterile lubricating gel
Describe the VE procedure
- If needed, clean vulva top to bottom
- Prepare equipment
- Put on sterile gloves and apply gel to ‘clean hand’
- Use ‘dirty hand to hold labia apart and assess
- Gently insert 2 ‘clean finger’, one at a time, down and back into vagina and assess
- Assess the cervix once identified
- Assess the cervix if able to enter
What should be assessed on the labia?
- Varicosities
- Lesions, warts, spots, cysts, scars
- PV loss, discharge/ liquor/ blood
- Redness, heat, moisture
- Oedema (swelling)
What should be assessed in the vagina?
- Muscle tone of vagina and pelvic floor
- Dryness and excess heat - signs of infection
What should be assessed for at the cervix?
- Position
- Consistency
- Length/ effacement
- Dilation
- Application to presenting part
- Abnormalities (e.g. oedema)
What should be assessed inside the cervix?
- Presence/ absence of membranes
- Presentation
- Station of presenting part
- Position of foetus
- Flexion/ attitude of head
- Presence of caput or moulding
- Abnormalities (e.g. presence of cord/ placenta)
What is the station of the presenting part in relation to?
Ischial spines
What do anterior and posterior refer to?
Anterior = towards mum's head Posterior = towards mum's feet
What are the 8 main positions?
- LOA (left occipitoanterior)
- LOP (left occipitoposterior)
- LOL (left occipitolateral)
- ROA (right occipitoanterior)
- ROP (right occipitoposterior)
- ROL (right occipitolateral)
- OA (occipitoanterior)
- OP (occipitoposterior)
What do flexed and deflexed mean?
Flexed = chin to chest Deflexed = head back
How should station be assessed?
- Same as engagement
- In relation to ischial spines
- Abdominal palpations
What is the difference between assessing engagement and station?
Station = VE Engagement = palpation
What should be done post examination?
- Auscultate foetal HR
- Ensure comfort and hygiene
- Discuss findings
- Ensure awareness of any pv loss noted
- Record keeping
- Plan of care
What should be documented?
- Abdominal palpation and FHR
- Reason for VE and consent
- External genitalia
- State of vagina
- Membranes and liquor
- Cervix position, consistency, effacement, dilation and presenting part
- Caput, moulding or abnormalities
- Foetal heart after VE
- Explanation of findings to mother and advice given
- Plan, including referral if necessary