INTERNAL EXAMINATION PROCEDURE

STEPS OF PROCEDURES
1. Prepare the materials to be used.
2. Explain in simple terms the procedure to the patient and make her feel comfortable.
3. Ask the patient to empty her bladder before the procedure. If the patient is in active labor
and already on the delivery table, empty the bladder by using a straight catheter
4. Provide privacy.
5. Assist the patient to a dorsal recumbent position in which the knees are slightly flexed.
6. Wash or flush the perineum. Pour an antiseptic solution over the vulva using a non-
dominant hand.
7. Wash hands or use an antiseptic hand rub.
8. Put on sterile examination gloves.
9. Apply lubricating jelly on tips of the second (index) and the third (middle) finger of the
examining hand/dominant hand.

10. Place a non-dominant hand on the outer edges of the woman’s vulva and spread her labia
with the thumb and little finger while inspecting the external genitalia for lesions. Look for red,
irritated mucous membranes; open, ulcerated sores; clustered or pinpoint vesicles.

11. Look for leaking amniotic fluid or the presence of umbilical cord or bleeding.
12. If there is no bleeding or a visible cord, insert the lubricated second (index) and the third
(middle) fingers deep into the vaginal OS up to the cervix in downward direction then sidewise.
Flex your fourth (ring) and fifth (small) fingers inward and the palm of the hand with the thumb
pointing forward.
13. Gradually rotate the hand in the process until the palm faces upward and the fingers
come in contact with the cervix. Palpate for cervical consistency and rate if firm or soft.
Measure the extent of dilatation; palpate for an anterior rim or lip of cervix.
14. Estimate the degree of effacement and estimate whether membranes are intact/ ruptured/
character of amniotic fluid (clear, bloody, greenish/meconium stained)
15. Locate the ischial spines and rate the station of the presenting part. Identify the presenting
part and fetal position (confirming findings obtained with Leopold’s maneuver) and note if
ischial spines are prominent or not prominent.
16. Determine the diagonal conjugate measurement whether >11.5 cm or <11.5 cm.
Determine pelvic architecture (optional).
17. Withdraw your hand. Wipe the perineum from front to back to remove secretions or
examining solutions.
18. Remove gloves and discard it in a leak-proof container or plastic bag and dispose of it
properly. Wash hands thoroughly or use antiseptic hand rub.
19. Leave the client comfortable and instruct her to turn to her side.
20. Document procedure and assessment findings and how the client tolerated the procedure
in the monitoring data of the woman’s record.
21. Manifests body mechanics throughout the performance of the procedures.
22. Receptive to criticisms and observes courtesy.
23. Shows calmness while performing the procedure.
24. Uses correct English and shows mastery of the procedure.
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