CHECKLIST ON INTERNAL EXAMINATION

Cases
1 2 3
1. Prepare articles completely.
2. Explain procedure.
3. Put the mother in a dorsal recumbent position.
4. Flush the perineum or soak the vulva.
5. Wash hands. Dry.
6. Put on sterile gloves.
7. Lubricate the two fingers of the left hand with antiseptic of K-Y jelly.
8. Separate the labia with the thumb and little finger of the right hand.
9. Insert the 2nd and 3rd fingers sidewise deep into the vagina.
10. Palms facing upward, sway the fingers on the wall of the vagina till they come intact
with the cervix.
11. Assess the following:
a. Condition of the cervix
Hard
Soft
Close
Open
Effacement / %
Dilation / cm
Position of Cervix
b. Presentation of fetus
Breech
Cephalic
Shoulder
Others
c. Position
LOA
LOP
ROA
ROP
Others
d. Station
-3
-2
-1
0
+1
+2
+3
e. Membranes
Intact
f. Pelvic architecture
1. Ischial spine
Prominent
Not prominent
2. Diagonal Conjugate
 11.5 cm (less than)
11.5 cm (greater than)
g. Assess vagina/perineum
Firm
Distensible
12. Check findings accurately with facilitator or clinical instructor
13. Record findings.

Remarks:

Patient: 1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
Student: ___________________
Date / Time: __________________
Clinical Instructor / Facilitator:
_________________________

Instructions:
Accomplish by using the legend according to observed task/activity.

Legend:
/ - d one
X – not done correctly
0 – not done