UNIT 2.
6
VAGINAL
EXAMINATION
Vaginal examination
■ It is a method to assess the condition of the
vagina, uterus, pelvis and progress of labor.
■ It is done periodically to determine cervical
dilatation, effacement and fetal distress.
Purposes
■ To detect the woman is in labor or not
■ To assess progress of labor (cervical dilatation and
effacement.
■ To detect fetal position, presentation and head engaged or
not.
■ To assess the adequacy of birth canal in relation to the fetus
■ To detect the likelihood of cord prolapse in polyhydraminous
and multiple pregnancy.
■ To determine the cause of delay in progress of labour.
■ To assess the degree of moulding.
Indications :
■Same as in purposes.
Contraindications :
An examination should not be carried out if there is any
history of vaginal bleeding, placenta previa, early rupture of
fore waters or preterm labor.
Articles required
■Articles for hand washing
■Makintosh and draw sheet
■Examination table
■Screen
■Light
CONTD…
■Antiseptic solution/ sterile water
■Bucket
■A trolley containing sterile :
o Bowl
o Perineal pads
o Sterile gloves
o Kidney tray
Procedure
■Prepare the examination table
■Prepare and check articles before starting the
procedure
■Check the light arrangement for better visualization
■Explain the procedure to the woman
■Bladder should be empty
Contd….
■Screen the bed to maintain privacy
■Always ask the woman’s consent before doing a
vaginal examination place the woman in dorsal
recumbent position.
■Ask the woman to uncover her genitalia area and cover
her to preserve privacy.
■Turn on light and direct it toward genital area.
■Wash your hand with soap and water and dry it.
■ gloves on both hand.
■Lubricate the first two fingers of right gloved hand.
■Clean the vulva and perineal area with a mild
anitiseptic solution. Wipe the vulva from the anterior
to posterior direction. Use a only once.
■check labia minora, clitoris, urethral opening, sores,
blood or foul smelling discharge, ulcers , warts, urine
or stool coming from vaginal opening after separating
the labia by two fingers of the hand.
■Palpate the labia minora, look for swelling discharge,
tenderness, ulcers and fistulas.
■Use two fingers of the right hand index and middle
fingers) and insert them gently into the vaginal orifice
without hurting the woman.
■Ask the woman to relax as much as possible by taking
a deep breathing.
■Determine the following : assess the status of the
cervix ( cervical dilatation, effacement), presenting
part, amniotic fluid , membrane and bloody show, bag
of water, presenting part, presentation, position, degree
of moulding, adequacy of the pelvic, status of
membrane., prolapse of cord.
■Withdraw finger and clean the area with sterile gauze
pieces to remove lubricate.
■Apply pad if necessary
■Assist her to dress and come down from the table.
■Discuss the findings of examination with the woman
and couple.
■Wash the gloved hand on decontamination solution
and remove gloves by turning them inside to out.
■Wash hands and dry them.
■Document the findings and report.
Methods of interpreting the
findings
■Dilatation of the cervix
■Rim of the cervix
Bag of waters
■ The bag of waters
■Level of station
■Diagnosis of presenting part
In 96% of case, the vertex is presentation and is
recognized by feeling the hard skull bones, the
fontanelles and sutures.
■Diagnosis of position
This is determined by recognizing which fontanelles lies
anteriorly i.e the posterior fontanelle in OA position, the
anterior fontanelle in OP Position and whether it is to the
left or right side of the pelvis.
■Degree of moulding:
It can be judged by feeling the amount of overlapping of
the skull bones, and when excessive.
■Abnormalities
Such as cord prolapse, cord presentation, hydrocephaly
and compound presentation can be diagnosed.
