Republic of the Philippines

SULTAN KUDARAT STATE UNIVERSITY

ACCESS. E.J.C. Montilla, Tacurong City

College of Health Sciences

PROCEDURES AND RATIONALE
ON INTERNAL EXAMINATION

PROCEDURE RATIONALE

1. Prepare the materials to be used. To be organized and manage the time as organization
and planning improve efficiency.

2. Explain in simple terms the Explanations ensure client cooperation and

procedure to the patient and make compliance.
her feel comfortable.

3. Ask the patient to empty her Full bladder can distort the findings and cause
bladder before the procedure. If pressure on the lower abdomen which makes the
the patient is in active labor and client uncomfortable.
already on the delivery table,
empty the bladder by using a
straight catheter

4. Provide privacy. Privacy enhances self-esteem.

5. Assist the patient to a dorsal To provide good visualization of the perineum.

recumbent position in which the
knees are slightly flexed.

6. Wash or flush the perineum. Pour Washing or flushing of the perineum and pouring of an
an antiseptic solution over the antiseptic are necessary to ensure the cleanliness of
vulva using a non-dominant hand. the area.

7. Wash hands or use an antiseptic Hand washing helps prevent the spread of
hand rub. microorganisms and nosocomial infections.

8. Put on sterile examination gloves. Use of a sterile glove prevents contamination of the
birth canal.

9. Apply lubricating jelly on tips of the
second (index) and the third
(middle) finger of the examining
hand/dominant hand.
Use of lubricating jelly helps to ease discomfort during
internal examination. NOTE: You may ask someone to
give you an amount of lubricating jelly on your
fingertips or you can prepare ahead of time an amount
of lubricating jelly on a sterile gauze.
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)
Presence of any lesions may indicate an infection and
possibly preclude vaginal birth.
Amniotic fluid implies membranes have ruptured and
umbilical cord may have prolapsed. Bleeding may be
a sign of placenta previa. Do not do a vaginal
examination if a possible placenta previa is present.
The cervix feels like a circular rim of tissue around a
center depression. A firm cervix feels similar to the tip
of the nose; while, soft cervix is as pliable as an
earlobe. The anterior rim is usually the last portion to
efface (thin). The width of the fingertips helps to
estimate the degree of dilatation. An index finger
averages about 1 cm; a middle finger about 1 ½ cm. If
they can both enter the cervix, the cervix is dilated 2 ½
to 3 cm. If there would be room for double the width of
your examining fingers in the cervix, the dilatation is
about 5 to 6 cm. When the space is four times the
width of your fingertips, dilatation is complete— 10 cm.
Measure the width of your fingertips on a centimeter
scale if you are going to do a vaginal examination, so
you know how wide your index and middle fingers are
at the tip.
Effacement is estimated in percentage depending on
thickness of the cervix before labor, usually at 2 to 2½
cm thick. If it is only 1 cm thick now, it is 50% effaced.
If it is tissue paper thin, it is 100% effaced.
The membranes (with a slight amount of amniotic fluid
in front of the presenting part) are the shape of a
watch crystal. Normal color of amniotic fluid is clear
and odourless, a greenish amniotic fluid indicates
meconium-staining, while a bloody-tinged amniotic

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 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.
fluid may be a sign of abruptio placenta.
Station is the number of centimeters above or below
the ischial spine where the presenting part is.
Identifying the presenting part confirms findings
obtained with Leopold’s maneuver. A vertex has a
hard, smooth surface with fetal hair may be palpable
but massed together and wet. Palpating the two
fontanelles, one diamond-shaped and one triangular,
helps the identification. Buttocks feel softer and have
bony prominence. Identifying the anus may be
possible because the sphincter action will “trap” the
index finger.
The diagonal conjugate is the alternative, measuring
from the inferior border of the pubic symphysis to the
sacral promontory and can be measured manually via
the vagina. NOTE: Use the tip of your middle finger to
measure the sacral promontory and then using the
other hand to mark the level of the inferior margin of
the symphysis pubis on the examining hand. Then,
use the distance between the index finger and the
pubic symphysis to measure the diagonal conjugate,
ideally 11cm or greater. Measuring the diagonal
conjugate helps assess the pelvic adequacy.
Use as gentle technique during withdrawal as with
insertion. Wiping front to back prevents moving rectal
contamination forward to the vagina.
Proper health care waste disposal of used gloves
should be on infectious waste containers.
Handwashing helps prevent spread of microorganisms
and nosocomial infections.
Side-lying is the best position to prevent supine
hypotension syndrome in labor.
Documentation provides a means for communication
and evaluation of care and client outcomes.
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
ACCESS. E.J.C. Montilla, Tacurong City

College of Health Sciences

PERFORMANCE CHECKLIST
ON INTERNAL EXAMINATION

Name: ________________________________________________Year Level: ____________

Inclusive Date: _________________

Direction: In using the checklist, please use the following rating scale in determining the
performance of the student.
5 Excellent: Student performs the procedure correctly, and perfectly. Student states the
rationale correctly and completely. Student is able to answer questions accurately.
4 Very Satisfactory: Student performs the procedure correctly. Student states the
rationale correctly but incompletely. Student is able to answer questions.
3 Satisfactory: Student performs the procedure correctly but failed to states the rationale.
Student is able to answer questions when cued.
2 Fair: Student performs the procedure when cued. Student fails to states the rationale.
Student is able to answer questions when cued.
1 Poor: Student fails to perform the procedure correctly even when cued. Student does
not know the rationale.

Objective:
The focus of the observation checklist is to assess the competencies of the students in
performing the step-by-step procedure on internal examination.

Equipment needed to prepare:

1) Sterile gloves (of appropriate size)
2) KY jelly/ water soluble lubricating jelly
3) Sterile or clean water
4) Antiseptic solution
5) Straight catheter

STEPS OR PROCEDURES ENCIRCLE RATING

PREPARATION E VS S F P
1. Prepare the materials to be used. 5 4 3 2 1
2. Explain in simple terms the procedure to the patient and 5 4 3 2 1
make her feel comfortable.
3. Ask the patient to empty her bladder before the procedure. If 5 4 3 2 1
the patient is in active labor and already on the delivery
table, empty the bladder by using a straight catheter
4. Provide privacy. 5 4 3 2 1
DURING THE PROCEDURE…
5. Assist the patient to a dorsal recumbent position in which the 5 4 3 2 1
knees are slightly flexed.
6. Wash or flush the perineum. Pour an antiseptic solution over 5 4 3 2 1
the vulva using a non-dominant hand.
7. Wash hands or use an antiseptic hand rub. 5 4 3 2 1
8. Put on sterile examination gloves. 5 4 3 2 1

9. Apply lubricating jelly on tips of the second (index) and the 5 4 3 2 1

third (middle) finger of the examining hand/dominant hand.
10. Place a non-dominant hand on the outer edges of the 5 4 3 2 1
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 5 4 3 2 1
cord or bleeding.
12. If there is no bleeding or a visible cord, insert the lubricated 5 4 3 2 1
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 5 4 3 2 1
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 5 4 3 2 1
membranes are intact/ ruptured/ character of amniotic fluid
(clear, bloody, greenish/meconium stained)
15. Locate the ischial spines and rate the station of the 5 4 3 2 1
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 5 4 3 2 1
>11.5 cm or <11.5 cm. Determine pelvic architecture
(optional).
17. Withdraw your hand. Wipe the perineum from front to back 5 4 3 2 1
to remove secretions or examining solutions.
POST-PROCEDURE
18. Remove gloves and discard it in a leak-proof container or 5 4 3 2 1
plastic bag and dispose of it properly. Wash hands
thoroughly or use antiseptic hand rub.
19. Leave the client comfortable and instruct her turn to her 5 4 3 2 1
side.
20. Document procedure and assessment findings and how 5 4 3 2 1
the client tolerated the procedure in the monitoring data of
the woman’s record.
For Clinical Instructor rating only…
5 4 3 2 1
21. Maintains body mechanics throughout the procedure.
22. Observes cleanliness and order in the performance. 5 4 3 2 1
23. Mastery and understanding of the procedure. 5 4 3 2 1
Sub -Total=
 Total Score: _______________
RD Grade: _______________

Instructors’ Remarks:
_____________________________________________________________________________
_____________________________________________________________________
_________________________________________________________________________

___________________________________________
Signature over Printed Name of Clinical Instructor