1. VAGINAL EXAMINATION

3. PRELIMINARIES Always be preceded by abdominal examination
Bladder must be empty

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

13. 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

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

15. CONTRAINDICATION
Undiagnosed vaginal bleedind
APH
Placenta previa