ALGORITHM 4 Inspection of cervix in Sims speculum Position of patient The gynaecological inspection is helded on a gynaecological arm-chair.

A woman lies on the back with half-bent in knee and heeps. Sims speculum, sterile glo es To e acuate urinary bladder and rectum, for some indications - necessary to perform an e acuant enema. ". ". #y the thumb and inde$ fingers of the left hand se$ual labias are opened. %. %. Speculum is grasped by the right right hand and inserted into agina, turning it firstly in obli&ue, later in direct position to pudendal cleft. '. '. To put a speculum on the back wall of agina and slightly press on it. (. (. The retractor is inserted in parallel direction inside the agina and pressing into anterior aginal wall. ). ). The cer i$ is inspected. *. *. After cer ical inspection the speculum and retractor are remo ed in re erse order+ retractor - at first, then speculum.

Necessary tool Preparation of patient !rder

ALGORITHM 5 Inspection of cervix in Cusco speculum Position of patient The gynaecological inspection is performed on a gynaecological arm-chair. A woman lies on the back with half-bent in knee and heeps. ,usco speculum, sterile glo es To e acuate a urinary bladder and rectum, if it is necessary cleansing enema is made.

Necessary tool Preparation of patient

!rder

". ". Sterile glo es are dressed. %. %. #y the thumb and inde$ fingers of

the left hand labias ma-or are opened in the lower third. '. '. A speculum is inserted in agina, placing blades parallel to the pudendal cleft. (. (. After insertion of the speculum A speculum is inside it is returned on ./ /, blades are fi$ed by lock in opened so that aginal part of cer i$ was some conditions. found between blades. ). After the cer ical inspection blades are remo ed from agina. ALGORITHM 6 T !in" sme rs for c#tolo"ic l ex min tion Position patient Necessary tool of A woman lies on a gynaecological armchair on the back with half-bent in knee and heeps. ,usco or Sims speculum, 0olchman spool, spatula 1yra or cer i$ brush for taking smears, pincers, wadding marble, sub-ect slide, sterile glo es. ". ". A patient is present on gynaecological arm-chair. %. %. To insert a gynaecological speculum into a agina, to e$amine a speculum. ".The material for research is taken from the anterior lateral ault making a scrub. To put the material on the slide. %. #y other instrument 2the best 3 by a brush4 the material is taken from cer icolumnar -unction 3 tran5ition 5one. 0or this purpose a brush is rotated into the channel of cer i$ on '*/. The recei ed material is putted on sub-ect slide, re ol ing a brush. '. 6f on the cer i$ there are some changes, a smear is taken also from the pathologically changed areas e$posed during colposcopy. ). A speculum is remo ed. *. The surname of the women is written in the special list, the material is sent to the

Preparation of patient

!rder

,arefully by the wadding marble clutched in pincers, tailings of mucus are taken off from the cer i$.

histological laboratory.

ALGORITHM $ T !in" of sme rs from

v "in for % cteriolo"ic l ex min tion

Position of A woman lies on the back with half-bent in patient knee and heeps. Necessary tool ,usco or Sims speculum, 0olcman spoon, 1yra spatula or cer i$brush for taking smears, pincers, wadding marble, sub-ect slide, sterile glo es. Preparation of ". The patient is presented in patient gynaecological arm-chair. %. To insert a gynaecological speculum into a agina, to e$amine the cer i$ in speculum. !rder ". A smear is taken from a posterior forni$, cer ical channel and urinary orifice by a aginal gynaecological spatula, uterine sound or cer i$brush. To put the scrub and to put the material on slide. %. A speculum is remo ed. '. The surname of the women is written in the special list, the material is sent to the histological laboratory. ALGORITHM & T !in" of sme r for "onorr'oe Position of A woman lies on the back with half-bent in patient knee andheeps. Necessary tool ,usco or Sims speculum, 0olcman spoon, 1yra spatula or cer i$brush for taking smears, pincers, wadding marble, sub-ect slide, sterile glo es. Preparation of ". The patient is presented in patient gynaecological arm-chair. %. To insert a gynaecological speculum into a agina, to e$amine the cer i$ in speculum !rder ". A smear is taken from a posterior forni$, cer ical channel and urinary orifice by a aginal gynaecological spatula, uterine sound or cer i$brush. To put the scrub and to put the material on slide. %. A speculum is remo ed.

'. The surname of the women is written in the special list, the material is sent to the histological laboratory. ALGORITHM ( )im nu l *pelvic+ ex min tion Position of patient Necessary tool Preparation of patient !rder A woman lies on the back with half-bent in knee and heeps. Sterile glo es ". The patient is present in gynaecological arm-chair 2before research urinary bladder and rectum are e acuated4. " 7ith thumb and inde$ fingers of the left hand labia ma-or are spreded. %. The middle and inde$ fingers of the right hand are inserted into agina, nameless and little finger are pressed to palm, and thumb finger is facing the pubis. '. 0ingers are placed into anterior forni$, the cer i$ is pushed backwards. (. #y an e$ternal hand carefully press on a anterior abdominal wall in direction to the fingers, which are located in agina. 6f the uterus is placed in position of ante ersioantefle$io, it will be found between the fingers of e$ternal and internal hands. ). The fingers of internal and e$ternal hands are located to the right from an uterus. 8ight adne$a are e$amined. *. The fingers of internal and e$ternal hands are located to the left of uterus. The left adne$a are e$amined. 9. The fingers of right hand are remo ed from agina.

If a woman is nor delivere, and vagina is narrow, at research a mid finger is entered at first, the back wall of vagina is pushed back , then an index finger is entered.

ALGORITHM ,-