{"id":1741,"date":"2010-12-13T11:11:40","date_gmt":"2010-12-13T11:11:40","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/internal-examination-during-parturition\/"},"modified":"2023-09-20T10:06:53","modified_gmt":"2023-09-20T09:06:53","slug":"internal-examination-during-parturition","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/obstetrics\/management-of-childbirth\/internal-examination-during-parturition\/","title":{"rendered":"Internal Examination During Parturition"},"content":{"rendered":"
\n

Cleaning The Vulva<\/strong><\/span><\/h3>\n

Materials to be laid out in preparation:<\/span><\/p>\n

    \n
  • Bowl with cotton wool balls in disinfectant.<\/span><\/li>\n
  • Kidney bowl.<\/span><\/li>\n
  • Sterile gloves.<\/span><\/li>\n<\/ul>\n
    \n

    Procedure<\/span><\/span><\/h3>\n
      \n
    • Wash your hands.<\/span><\/li>\n
    • Put on the sterile gloves.<\/span><\/li>\n
    • Tell the woman what is going to happen and why.<\/span><\/li>\n
    • Ask the woman to lie on her back with her legs slightly flexed and spread.<\/span><\/li>\n
    • Take a cotton wool ball and squeeze it out above the bowl.<\/span><\/li>\n
    • Clean the area around the vulva and the labia major.<\/span><\/li>\n
    • With each cotton wool ball wipe just once ventrally to dorsally.<\/span><\/li>\n
    • Discard the used cotton wool ball in the kidney bowl or the waste bucket.<\/span><\/li>\n
    • Spread the labia minor at the height of the vaginal orifice by placing the thumb and index finger between the labia minor and major and moving laterally.<\/span><\/li>\n
    • Clean the folds between the labia major and minor in the same manner.<\/span><\/li>\n
    • Keep the labia spread and with a wiping movement go from the external urethral orifice via the vaginal orifice and the perineum to the anus.<\/span><\/li>\n
    • Keep wiping ventrally to dorsally making just a single wipe with each cotton wool ball.<\/span><\/li>\n
    • Discard the used cotton wall balls in a kidney bowl or waste bucket.<\/span><\/li>\n<\/ul>\n
      \n

      Digital Vaginal Examination<\/strong><\/span><\/h3>\n

      The digital vaginal examination during the dilation stage serves to gain an impression of how far dilation<\/strong> and engagement have progressed<\/strong>, the position of the child<\/strong> and the accessibility of the birth canal<\/strong>. The examination should preferably not take place during a contraction. This will be less unpleasant for the woman and will provide the most reliable information. Vaginal examination only takes place during a contraction to assess whether the membranes are still intact and functional.<\/span>
      \nDuring the dilation stage several vaginal examinations may be performed to establish the progression over the course of time. The last vaginal examination serves to establish whether the following stage, the delivery stage, can and may begin.<\/span><\/p>\n

      The term CDMSPL <\/strong>is an aid for noting the findings of the digital vaginal examination. It is an acronym that is formed by the first letters of the following words.<\/span><\/p>\n

      Cervical effacement.<\/strong><\/em> During the dilation stage, changes take place in the cervix. The cervix becomes shorter, softer and opens. The process of the cervix shortening and eventually merging completely with the lowest uterine segment is referred to as cervical effacement [Figure 23]<\/strong><\/em>.<\/span><\/p>\n

      Dilation<\/strong><\/em>.<\/strong> Using the outer sides of the two vaginal fingers, an estimation is made of how far open the cervix is in centimetres.<\/span><\/p>\n

      Membranes.<\/strong><\/em> The examiner feels whether the amniotic sac is still present, in other words, whether there is amniotic fluid between the presenting part of the foetus and the vaginal fingers. They also note whether the amniotic sac becomes taut during a contraction, thereby contributing to the contraction by exerting pressure on the cervix. If that is the case, the membranes are still functional. If the membranes have not ruptured, they are described as being intact.<\/span><\/p>\n

      Station.<\/strong><\/em> The foetal station (engagement<\/em>) is established by determining the relationship between the presenting foetal part and the maternal pelvis. The position of the lowest part of the presenting part is compared to a number of reference points in the bony pelvis. The relationship is expressed in terms of having reached a particular plane according to Hodge [Figure 24]<\/strong><\/em>.<\/span><\/p>\n

      Presentation<\/strong><\/em>.<\/strong> The deepest (in the case of vaginal examination, the most accessible<\/em>) part of the presenting part is palpated and it is noted whether this is the head or the buttocks. This will already have been determined by means of the external examination (Leopold\u2019s manoeuvres<\/em>) but the vaginal examination provides more reliable information about the presentation. A head feels hard and round, with a smooth surface and fontanels and a sagittal suture. The buttocks feel firm, irregular in shape, the sacrum can clearly be felt and sometimes the feet or legs can be palpated.<\/span><\/p>\n

      Lie and attitude of the foetus<\/strong><\/em>.<\/strong> The sagittal suture is felt for and, in the case of a vertex position, the large and\/or small fontanel should be identified. In the case of a breech position, the foetal sacrum and\/or the ischial tuberosities should be identified.<\/span><\/p>\n

      \"\"Figure 23: Effacement of the cervix.<\/span><\/strong><\/span><\/p>\n

      – Left-hand column (from top to bottom) – In nullipara, effacement precedes dilation.
      \n– Right-hand column – In multipara, dilation of the vaginal portion of the cervix starts during effacement.<\/em><\/span><\/p>\n

      \"\"Figure 24<\/span><\/strong><\/span><\/p>\n

      Contraindications for a vaginal examination:<\/em><\/span><\/p>\n

        \n
      • Absolute: Clear red vaginal blood loss.<\/span><\/li>\n
      • Relative: Amniotic fluid loss without contraction activity.<\/span><\/li>\n<\/ul>\n

        Preparation:<\/em><\/span><\/p>\n

          \n
        • The woman\u2019s bladder must be empty.<\/span><\/li>\n<\/ul>\n

          Procedure<\/span><\/h3>\n
            \n
          • Wash your hands.<\/span><\/li>\n
          • Tell the woman what is going to happen and why.<\/span><\/li>\n
          • Put on the sterile gloves.<\/span><\/li>\n
          • Clean the vulva.<\/span><\/li>\n
          • Spread the labia minor at the height of the vaginal orifice by placing the thumb and index finger between the labia major and minor and moving them laterally.<\/span><\/li>\n
          • Keep the labia spread in this manner until the examining fingers have been inserted deep enough to feel the cervix.<\/span><\/li>\n
          • Adopt a stable posture and digitally examine with a relaxed wrist, holding the forearm roughly horizontally.<\/span><\/li>\n
          • Insert the first third of the middle finger of the examining hand past the anterior wall of the vagina.<\/span><\/li>\n
          • Make space for the index finger of the examining hand by exerting some perineal pressure with the inserted middle finger.<\/span><\/li>\n
          • Push the index finger of the examining hand past the middle finger.<\/span><\/li>\n
          • Avoid pressure on the urethra and keep the thumb of the examining hand away from the clitoris.<\/span><\/li>\n
          • Insert the relaxed fingers as deep as possible into the vagina and support the fundus of the uterus with the other hand.<\/span><\/li>\n
          • Note the following:<\/span>\n
              \n
            • The Cervix<\/strong><\/span>\n
                \n
              • Position with respect to the vaginal axis (symphysis pubis, centrally, sacrally<\/em>).<\/span><\/li>\n
              • Shape (position, effaced<\/em>).<\/span><\/li>\n
              • Estimated length.<\/span><\/li>\n
              • Consistency (firm, soft<\/em>).<\/span><\/li>\n
              • Thickness of cervical rim (in case of effaced cervix<\/em>).<\/span><\/li>\n<\/ul>\n<\/li>\n
              • Opening<\/strong><\/span>\n
                  \n
                • Estimated dilation in centimetres.<\/span><\/li>\n<\/ul>\n<\/li>\n
                • Membranes<\/strong><\/span>\n
                    \n
                  • Intact\/not intact.<\/span><\/li>\n<\/ul>\n<\/li>\n
                  • Station<\/strong><\/span>\n
                      \n
                    • The deepest presenting part of the foetus at the height of the first, second, third or fourth Hodge\u2019s plane [Figure 24]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<\/li>\n
                    • Presentation<\/strong><\/span>\n
                        \n
                      • Head.<\/span><\/li>\n
                      • Buttocks.<\/span><\/li>\n<\/ul>\n<\/li>\n
                      • Position<\/strong><\/span>\n
                          \n
                        • Head.<\/span><\/li>\n
                        • Buttocks.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n
                        • Note the following:<\/span>\n
                            \n
                          • Pain.<\/span><\/li>\n<\/ul>\n
                              \n
                            • Prolapsed limbs or umbilical cord.<\/span><\/li>\n
                            • The soft tissue of the birth canal (consistency<\/em>).<\/span><\/li>\n
                            • Pelvic floor.<\/span><\/li>\n
                            • Rectum (full or empty<\/em>).<\/span><\/li>\n<\/ul>\n<\/li>\n
                            • Remove examining fingers carefully from the vagina.<\/span><\/li>\n
                            • Check the gloves for:<\/span>\n
                                \n
                              • Blood.<\/span><\/li>\n
                              • Meconium.<\/span><\/li>\n
                              • Mucus.<\/span><\/li>\n
                              • Flakes of vernix in the amniotic fluid.<\/span><\/li>\n<\/ul>\n<\/li>\n
                              • Note the findings.<\/span><\/li>\n
                              • Note the time of the digital examination.<\/span><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

                                Cleaning The Vulva Materials to be laid out in preparation: Bowl with cotton wool balls in disinfectant. Kidney bowl. Sterile gloves. Procedure Wash your hands. Put on the sterile gloves. Tell the woman what is going to happen and why. Ask the woman to lie on her back with her legs slightly flexed and spread. […]<\/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":[58],"tags":[138],"class_list":["post-1741","post","type-post","status-publish","format-standard","hentry","category-management-of-childbirth","tag-obstetrics"],"acf":[],"yoast_head":"\nInternal Examination During Parturition - 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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