VAGINAL EXAMINATION CASE NO.

Hospital _______________________________LR ________________ Reg. No.

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Name of the patient ___________________W/O_______________ Age _____ Religion
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Address ____________________________________________________________________________
Parity

EXAMINATION FINDINGS:1. VAGINAL EXAMINATION:

Vulva & Perineum

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Vagina
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Cervix
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Presenting Part
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Position of the Foetus
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Bag of Membranes
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Suture
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Fontenelles
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Station of the Fetal Head
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2. PELVIC ASSESSMENT:

Sacral Promontory
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Sacrosciatic Notch
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Side Walls
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Ischial spines
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Bispinous Diameter
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Sub Pubic Arch
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Transverse Diameter of Outlet

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Signature of the
Teacher _________________