This is a systematic sensitive assessment of the vagina performed by a Midwife by inserting her index and middle fingers into the vagina to ascertain various physiological changes and abnormalities in the birth canal during labour. It is normally done 4 hourly unless otherwise indicated. It requires adequate preparation of the woman on the purpose and rationale.
Aims
· Make positive diagnoses of labour
· Monitor cervical dilatation, consistency and position of the cervix
· Determine engagement of the descent of the presenting part
· Determine whether membranes have ruptured or rupture it artificially
· Confirm full dilation of the cervix
· Identify possible cord prolapse after the membranes have ruptured
· Assess progress or delay in labour
· Confirm the presentation of the second twin in multiple pregnancy
· Assess the adequacy of the pelvis
· Determine the position of the presenting of the foetus
· Apply a foetal scalp electrode
Types
· Digital
· Speculum
Requirements
Sterile vaginal exam pack containing the following:
· Gallipot
· Two Receivers
· Amniotic forceps or hook
· Sponge holding forceps
· Swabs
· Disposable Towels
· Antiseptic Solution e.g. savlon
· Antiseptic vaginal cream or sterile lubricant e.g. Hibitane cream
· A pair of sterile gloves
· Perineal pad
· Mackintosh apron
· Mackintosh
· Draw sheet
· Drape
Steps
1. Explain the procedure to the client (Refer steps)
2. Help client to empty bladder and provides privacy
3. Protect bed with mackintosh and assist client to lie on her side
4. Perform hand hygiene and wear protective clothing
5. Instruct client to assume the dorsal position with legs flexed and knees apart
6. Drape client and asks client to expose vulva
7. Inspect vulva and swabs with strokes from upwards downwards starting with the labia majora
8. Separate the labia minora and swabs vestibule using a swab for each stroke
9. Using the right hand, the middle and index fingers are inserted gently into the vagina pressing firmly downwards
10. Speculum is use when indicated (premature rupture of membranes, premature labour)
11. Assess the cervix for degree of dilatation and moulding, rupture of membranes, liquor, presenting part, position and adequacy of the pelvis
12. Withdraw examining fingers gently and observe
13. Tidy up client, apply clean perineal pad
14. Put client back in a comfortable position and communicate findings to her
15. Appreciate client for her cooperation
16. Dispose off used items and decontaminate
17. Perform hand hygiene
18. Record and report findings to Officer in-charge
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