VAGINAL/CERVICAL EXAMINATION

CRISTIN G. UNGAB, MN
OVERVIEW

 IS AN extremely intimate examination which is

performed regularly and accepted as a routine
procedure by midwives during labor
 Examination done per vagina to assess the status of
vagina, cervix and progress of descent of fetus
through the birth canal
 Also known as internal examination (IE) or
cervical examination and bimanual digital
examination
 indicator of labor progress
OVERVIEW

 used to assess the degree of opening of the

cervix so that the labor progress and time of
birth can be estimated
 a woman in labor is often subjected to at
least one VE, and often these are repeated
every 4 hours on obstetric orders or according
to the practice requirements of the birth unit
 As the average labor lasts between 8 and 12
hours, most women can expect to have at least
two or three VEs during their labor
OVERVIEW
 a thorough VE can determine the
location of the presenting fetal part (the
relationship of the presenting fetal part
to an imaginary line drawn between the
ischial spines of the pelvis, the status of
the membranes) and fetal well-being
through scalp stimulation
 Series of cervical examinations are used
to determine cervical dilation,
effacement, and fetal position, also
known as the station
 PURPOSE

 Cervical/vaginal exam or IE are

employed to evaluate the
following:
 Dilatation: Referring to how
wide the cervix has opened (10
centimeters being the widest)
PURPOSE

 Cervical/vaginal exam or IE
are employed to evaluate the
following:
 Ripening: refers to the
consistency of the cervix. It
starts out feeling firm like
the tip of a nose, softens to
feel like an ear lobe, and
eventually softens further
to feel like the inside of a
cheek
PURPOSE
 Cervical/vaginal exam or IE are
employed to evaluate the
following:
 Effacement: This is how thin
the cervix is. If you think of the
cervix as funnel-like and
measuring about 2 inches long,
you will see that 50-percent
effaced means that the cervix is
now about 1 inch in length. As
the cervix softens and dilates,
the length decreases as well.
 PURPOSE

 Cervical/vaginal exam or IE
are employed to evaluate the
following:
 Fetal Station: This is the
position of the baby in relation to
the pelvis, measured in pluses and
minuses. A baby who is at zero
station is said to be engaged while
a baby in the negative numbers is
said to be floating. The positive
numbers are the way out!
PURPOSE

 Cervical/vaginal exam or IE are employed

to evaluate the following:
 Fetal Position: By feeling the suture lines on the
skull of the baby, where the four plates of bone
haven't fused yet, a practitioner can tell which
direction the baby is facing because the anterior and
posterior fontanels (soft spots) are shaped differently.
 EQUIPMENT

 Sterile Gloves
 KY jelly
(lubricating jelly)
PROCEDURE

1. Introduce yourself.
2. Verify the client’s name.
3. Inform the client about the procedure and explain that you are about to perform an
internal examination of the vagina and the uterus using fingers.
4. Obtain her verbal consent.
5. Wash hands.
PROCEDURE

6. Ask her to empty bladder.

7. Assure privacy and ask for
a chaperone.
PROCEDURE

8. Ask to lie on the couch and undress,

waist down.
9. Provide drape.
10. Position her on back, hips and knees
flexed (dorsal recumbent) and thighs
abducted.
WEAR A
STERILE
GLOVES.
USE
LUBRICATING
GEL TO
LUBRICATE
THE RIGHT
INDEX FINGER
AND MIDDLE
FINGER.
THE LABIA
ARE GENTLY
PARTED WITH
THE GLOVED
INDEX FINGER
AND THUMB
OF THE LEFT
HAND.
ENTER WITH
THE PALM
FACING
SIDEWAYS,
THEN ROTATE
SO THE PALM
IS FACING
UPWARDS.
PROCEDURE

11.Initially, the lubricated index finger of the examiner’s right hand is inserted through
the introitus into the vaginal canal.
PROCEDURE

21.If patient is comfortable with this, the

lubricated middle finger of the same
hand is also inserted. If not, due to
pain, a limited bimanual examination
with one finger can be performed.
22.The full length of the finger is
introduced, assessing the vaginal
walls in transit until the cervix is
located.
PROCEDURE

23. Fingers locate the cervix and cervical os and evaluate the following:
 Cervical dilatation
 Cervical effacement
 Ripening
 Fetal presentation
 Fetal position
PROCEDURE

24.Remove fingers gently and inspect for discharge or blood.

25.Thank the patient and allow them to get dressed in private.
26.Remove your gloves and wash your hands.
Link: https://youtu.be/x17vY7_3M2M