{"id":1701,"date":"2010-12-13T08:18:05","date_gmt":"2010-12-13T08:18:05","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/internal-pelvic-examination\/"},"modified":"2023-09-07T16:53:53","modified_gmt":"2023-09-07T15:53:53","slug":"internal-pelvic-examination","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/obstetrics\/first-check-up\/internal-pelvic-examination\/","title":{"rendered":"Internal Pelvic Examination"},"content":{"rendered":"<p><span style=\"color: #000000;\">Opinions differ regarding the value of routine <strong>internal pelvic examination<\/strong> for assessment of the small, bony pelvis as a birth canal. One <strong>disadvantage<\/strong> of not performing an internal pelvic examination, or postponing the internal pelvic examination until late in the pregnancy can be that the head or the buttocks is <strong>too deeply descended<\/strong> into the pelvis for a reliable examination to take place. Under special circumstances, if the child is lying in the breech position in a nulliparous woman, previously-performed reliable pelvic examination is crucial for determining future management.<\/span><\/p>\n<h2><\/h2>\n<h3><span style=\"text-decoration: underline;\"><span style=\"color: #000000; text-decoration: underline;\">Procedure<\/span><\/span><\/h3>\n<ul>\n<li><span style=\"color: #000000;\">Insert the examining fingers behind the symphysis <em><strong>[Figure 5]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #000000;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1693\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-5.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-5.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-5-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 5<\/span><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">Feel for irregularities, such as a <strong>ridge<\/strong> on the symphysis.<\/span><\/li>\n<li><span style=\"color: #000000;\">Feel the <strong>linea terminalis<\/strong> by allowing both fingers to follow the edge of the pelvic brim from the symphysis to the sacral promontory <strong><em>[Figure 6]<\/em><\/strong>. Normally, the linea terminalis cannot be followed for <strong>more than 2\/3<\/strong> its length.<\/span><\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #000000;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1694\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-6.jpg\" alt=\"\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-6.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-6-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 6<\/span><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">Determine the <strong>diagonal conjugate<\/strong>. This is the distance from the lower edge of the symphysis to the sacral promontory.<\/span><\/li>\n<li><span style=\"color: #000000;\">Place the radial side of the index finger against the lower edge of the symphysis.<\/span><\/li>\n<li><span style=\"color: #000000;\">Localise the sacral promontory with the tip of the middle finger. Normally, the promontory will be out of reach <em><strong>[Figure 7]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #000000;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1695\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-7.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-7.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-7-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 7<\/span><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">However, if the sacral promontory can be reached, place the index finger of the other hand as close as possible against the symphysis and place this finger against the internal finger <em><strong>[Figure 8]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #000000;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1696\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-8.jpg\" alt=\"\" width=\"400\" height=\"400\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-8.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-8-100x100.jpg 100w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-8-300x300.jpg 300w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-8-150x150.jpg 150w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 8<\/span><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">Remember this marking point. Once the examination has been completed, measure the distance from the marking point to the top of the middle finger using a tape measure. To calculate the true conjugate, <strong>subtract 1.5 cm<\/strong> from this distance measured (<em>diagonal conjugate<\/em>).<\/span><\/li>\n<li><span style=\"color: #000000;\">Feel along the sacrum from the promontory to the coccyx <strong><em>[Figure 9]<\/em><\/strong>:<\/span>\n<ul>\n<li><span style=\"color: #000000;\">The sacrum should be <strong>biconcave<\/strong> (<em>curved in both the transverse and longitudinal planes<\/em>).<\/span><\/li>\n<li><span style=\"color: #000000;\">The sacrum should contain <span style=\"text-decoration: underline;\">no ridges<\/span>.<\/span><\/li>\n<li><span style=\"color: #000000;\">The coccyx should not be pointing <span style=\"text-decoration: underline;\">inwards<\/span>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #000000;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1697\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-9.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-9.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-9-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 9<\/span><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">Determine if the <strong>ischial spines<\/strong> protrude more inwardly than normal <em><strong>[Figure 10]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #000000;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1698\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-10.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-10.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-10-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 10<\/span><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">Determine the width of the <strong>pubic arch<\/strong>. Do this by placing the index and middle finger of the right hand next to each other in the angle of the arch<em><strong> [Figure 11]<\/strong><\/em>. The width is normal if the angle is <strong>90\u00b0<\/strong>. In principle, this may be assumed if two fingers can be placed next to each other in the pubic arch angle.<\/span><\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #000000;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1699\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-11.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-11.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-11-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 11<\/span><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">Remove the fingers from the vagina.<\/span><\/li>\n<li><span style=\"color: #000000;\">Make a fist.<\/span><\/li>\n<li><span style=\"color: #000000;\">Measure the distance between the ischial tuberosities<em><strong> [Figure 12]<\/strong><\/em>. Normally, four knuckles of a male hand (<em>about 9 to 10 cm<\/em>) will fit tightly between the ischial tuberosities. A female hand is about 2 cm smaller.<\/span><\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #000000;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1700\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-12.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-12.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-12-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 12<\/span><\/strong><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Opinions differ regarding the value of routine internal pelvic examination for assessment of the small, bony pelvis as a birth canal. One disadvantage of not performing an internal pelvic examination, or postponing the internal pelvic examination until late in the pregnancy can be that the head or the buttocks is too deeply descended into the [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[56],"tags":[138],"class_list":["post-1701","post","type-post","status-publish","format-standard","hentry","category-first-check-up","tag-obstetrics"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Internal Pelvic Examination - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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