How is pv done

Assess the state of the cervix. Assess the presenting part. Assess the size of the pelvis. Preparation for a vaginal examination in labour A. Equipment that should be available for a sterile vaginal examination A vaginal examination in labour is a sterile procedure if the membranes have ruptured or are going to be ruptured during the examination.

The basic necessities are: Swabs. Tap water for swabbing. Sterile gloves. A suitable instrument for rupturing the membranes. An antiseptic vaginal cream or sterile lubricant. Preparation of the patient for a sterile vaginal examination Explain to the patient what examination is to be done, and why it is going to be done.

The woman needs to know that it will be an uncomfortable examination, and sometimes even a little painful. The patient should lie on her back, with her legs flexed and knees apart. Do not expose the patient until you are ready to examine her. It is sometimes necessary to examine the patient in the lithotomy position. This is done by first swabbing the labia majora and groin on both sides and then swabbing the introitus while keeping the labia majora apart with your thumb and forefinger.

Sterile gloves must be worn. The examiner must think about the findings, and their significance for the patient and the management of her labour. Procedure of examination A vaginal examination in labour is a systematic examination, and the following should be assessed: Vulva and vagina.

Presenting part. Always examine the abdomen before performing a vaginal examination in labour. An abdominal examination should always be done before a vaginal examination.

The vulva and vagina D. Important aspects of the examination of the vulva and vagina This examination is particularly important when the patient is first admitted: When you examine the vulva you should look for ulceration, condylomata, varices and any perineal scarring or rigidity. When you examine the vagina, the presence or absence of the following features should be noted: A vaginal discharge. A full rectum. A vaginal stricture or septum. Presentation or prolapse of the umbilical cord.

A speculum examination, not a digital examination, must be done if it is thought that the patient has preterm or prelabour rupture of the membranes. The cervix When you examine the cervix you should observe: Length. Measuring cervical length The cervix becomes progressively shorter in early labour. Dilatation Dilatation must be assessed in centimetres, and is best measured by comparing the degree of separation of the fingers on vaginal examination, with the set of circles in the labour ward.

In assessing the dilatation of the cervix, it is easy to make two mistakes: If the cervix is very thin, it may be difficult to feel, and the patient may be said to be fully dilated, when in fact she is not. When feeling the rim of the cervix, it is easy to stretch it, or pass the fingers through the cervix and feel the rim with the side of the fingers. Both of these methods cause the recording of dilatation to be more than it really is.

The correct method is to place the tips of the fingers on the edges of the cervix. Figure 8B The correct method of measuring cervical dilatation The membranes and liquor G. Assessment of the membranes Rupture of the membranes may be obvious if there is liquor draining. If the membranes are intact, the following two questions should be asked: Should the membranes be ruptured?

In most instances, if the patient is in the active phase of labour, the membranes should be ruptured. When the presenting part is high, there is always the danger that the umbilical cord may prolapse. However, it is better for the cord to prolapse while the hand of the examiner is in the vagina, when it can be detected immediately, than to have the cord prolapse with spontaneous rupture of the membranes while the patient is unattended.

Women living with HIV, unless their viral load is lower than detectable, and women in preterm labour should not have their membranes ruptured unless there is poor progress of labour. Women should have their first pelvic exam at age 21 unless other health issues require it earlier.

Often the first pelvic exam is when a young woman goes to seek birth control. Women over the age of 21 should receive regular pelvic exams, similar to general checkups.

However, special reasons for having a pelvic exam include:. Schedule your pelvic exam for a date when you will not be on your period. However, if you have a menstrual issue you are concerned about, your doctor may suggest an examination during your period.

Avoid vaginal intercourse, inserting anything into your vagina, and douching, at least 24 hours before your pelvic exam. Your doctor will have you undress and put on a robe. You may be given something to put around your waist for added privacy.

You will lie on an exam table with your legs spread and your feet on footrests called stirrups. First, your doctor will visually inspect your vagina and vulva. Your doctor may be looking for redness, irritation, discharge, cysts, or something that indicates a sexually transmitted disease, such as sores.

Next, the doctor will insert an instrument known as a speculum into the vagina. The speculum is a stainless steel or plastic device that resembles a duckbill.

Women should breathe deeply and try to relax their vaginal, rectal, and abdominal muscles during insertion. Sometimes doctors will warm up the speculum beforehand. The doctor may swipe the cervix, before removing the speculum, with something that looks like a small spatula. During a pelvic exam, a doctor evaluates your reproductive organs. You might have a pelvic exam as part of your regular checkup.

Or your doctor might recommend a pelvic exam if you have symptoms such as unusual vaginal discharge or pelvic pain. A pelvic exam usually lasts only a few minutes. Your doctor checks your vulva, vagina, cervix, ovaries, uterus, rectum and pelvis for any abnormalities. A Pap test, which screens for cervical cancer, is often performed during a pelvic exam. To assess your gynecological health. A pelvic exam often is part of a routine physical exam to find possible signs of ovarian cysts, sexually transmitted infections, uterine fibroids or early-stage cancer.

Pelvic exams are also commonly performed during pregnancy. There is a lot of debate among experts regarding the recommended frequency of pelvic exams. Ask your doctor what he or she recommends. You don't need to do anything special to prepare for a pelvic exam. For your own comfort, you might want to schedule your pelvic exam on a day when you don't have your period. Also, you might be more comfortable if you empty your bladder before the exam.

If you have questions about the exam or its possible results, consider writing down your questions and taking them with you to the appointment so that you don't forget to ask them. You'll be asked to change out of your clothes and into a gown. You might be given a sheet to wrap around your waist for added privacy. This will allow me to assess the vagina, womb and ovaries. You can ask me to stop at any point.

Do you have any questions? Are you happy for me to carry out the examination? Ask the patient if they have any pain or if they think they may be pregnant before proceeding with the clinical examination. Provide the patient with the opportunity to pass urine before the examination.

Provide the patient with privacy to undress and check it is ok to re-enter the room before doing so. An abdominal examination should always be performed before moving onto vaginal examination.

This may be less thorough than a full abdominal examination, but should at least include inspection and palpation of the abdomen. Inspect for evidence of vaginal prolapse a bulge visible protruding from the vagina. Asking the patient to cough as you inspect can exacerbate the lump and help confirm the presence of prolapse. Female genital mutilation FGM is defined by the WHO as all procedures that involve partial or total removal of the external female genitalia , or other injury to the female genital organs for non-medical reasons.

Typical findings on clinical examination include a unilateral , fluctuant mass , which may or may not be tender. Lichen sclerosus is a chronic inflammatory dermatological condition that can affect the anogenital region in women. It presents with pruritis and clinical examination typically reveals white thickened patches. Destructive scarring and adhesions develop causing distortion of the normal vaginal architecture shrinking of the labia, narrowing of the introitus, obscuration of the clitoris.

There are several causes of abnormal vaginal discharge including:. Carefully separate the labia using the thumb and index finger of your non-dominant hand.

Gently insert the gloved index and middle finger of your dominant hand into the vagina. Enter the vagina with your palm facing laterally and then rotate 90 degrees so that your palm is facing upwards.

Palpate the walls of the vagina for any irregularities or masses. The fornices are the superior portions of the vagina, extending into the recesses created by the vaginal portion of the cervix. Place your non-dominant hand 4cm above the pubis symphysis.

Push upwards with the internal fingers whilst simultaneously palpating the lower abdomen with your non-dominant hand. You should be able to feel the uterus between your hands. You should then assess the various characteristics of the uterus:. The term adnexa refers to the area that includes the ovaries and fallopian tubes.