VAGINAL EXAMINATION

PRELIMINARIES Always be preceded by abdominal examination Bladder must be empty

INDICATIONS To make positive diagnosis of labour To make a positive identification of presentation To determine whether the head is engaged or not To ascertain whether the forewaters have ruptured To rupture the forewater artificially To exclude cord prolapse To assess progress or delay in labour To apply fetal scalp electrode To confirm full dilatation of the cervix

PROCRDURE Aseptic precaution Explain the procedure Women must lie on her back, the thighs should be separated and the knees bent Two fingers of the dominat hand dipped in antiseptic cream and gently inserted downward and backward into the vagina Fingers are directed along the anterior vaginal wall Should not withdraw the fingers until the required information is obtained

FINDINGS EXTERNAL GENITALIA Observe the labia for any signs of varicosities, edema or vulval warts or sores Scarring of the perineum from previous episiotomy Note discharge or bleeding from vaginal orifice Colour and odour of amniotic fluid

FINDINGS……Contd CONDITION OF VAGINA Vagina should feel warm and moist Walls are soft and distensible A hot, dry vagina is a sign of obstructed labour Wall rigid and firm longer labour can be anticipated Loaded rectum can be felt through posterior vaginal wall

FINDINGS……Contd THE CERVIX Palpate around the orifice Sense the proximity of presenting part A spongy feel between finger and presenting part may indicate placenta previa OS Uteri is located gently by palpating from side to side Normally situated centrally but in early labour it will be very posterior A long tightly closed cervix indicates that labour has not yet started In primigravida the cervix may be completely effaced still closed Consistency of the cervix may be soft and elastic

FINDINGS……Contd UTERINE OS 10 CM dilatation equates to full dialatation THE FOREWATER Intact membrane can be felt through the dilating os Slack when felt between contraction and tense when the uterus contracts

FINDINGS……Contd LEVEL OR STATION OF THE PRESENTING PART The presenting part is defined as the part of the fetus lying over the uterine os during labour Level of the presenting part is estimated in relation to the maternal ischial spine IDENTITY OF THE PRESENTATION Vertex presents it can be identified by feeling the hard bones of the vault of the skull and the fontanelles and sutures

FINDINGS……Contd POSITION Feel for sagittal sutures The location of the fontanelles in relation to the pelvis will give the information as to the whereabouts of the occiput

FINDINGS……Contd MOULDING Overlapping of the skull bones Parital bones override the occipital bone Anterior parital bone overrides the posterior PELVIC CAPACITY Ischial spine should be blunt Size of the subpubic angle should be 90 degree and accomadate the two examining fingers

COMPLETION OF THE EXAMINATION Withdraw fingers from the vagina she should note any blood or amniotic fluid and compare with the observations earlier

CONTRAINDICATION Undiagnosed vaginal bleedind APH Placenta previa