Flashcards in Vaginal Examinations Deck (25)
Give some psychological and emotional issues surrounding VE
- Can be painful, distressing, embarrassing, invasive
- Issues of sexual intimacy, vulnerability, sexual abuse, physical abuse, rape
- Give women opportunity to disclose issues when fully clothed
- Examination should not proceed if it causes distress
What is vaginismus?
- Fear of penetration
- Relates to past experiences or of unknown origin
- May need referral to psychosexual counselling
Give some consent issues surrounding VE
- Should be verbal and informed
- Without coercion
- Should be gained for each separate procedure
- Without consent, a VE is assault
- Consent can be withdrawn at any stage
- Must be obtained prior to procedures under anaesthetic
What is coercion?
Who should special considerations be made for when gaining consent?
- Learning difficulties
- Mental illness
- Cultural, ethnic and religious diversities
Give some reasons for a VE to be carried out
- To confirm onset of labour
- Determine presentation, attitude and position
- Assess progress/delay in labour
- To apply Foetal Scalp Electrode/ FBS
- Screening/ diagnostic purposes
- To assess trauma post-delivery
- Maternal request
What are some contra-indications for VE?
- Vaginal bleeding
- Placenta praevia
- Preterm labour
- Preterm rupture of membranes
- No consent given
What is a speculum?
- Holds vagina open to shine torch down so VE can be done visually
- Only for specified circumstances such as pre-labour rupture of membranes
What should be considered prior to the VE?
-- Can you document a clear reason for performing a VE?
- Is there another non-invasive way to acquire info?
- Are you following policies and guidelines?
Give some alternative approaches to a VE
- Listen to woman
- Watch for behaviour changes
- Look for changes in FHR
- External signs (e.g. purple line, labial gaping, anal dilation)
How should you prepare for a VE?
- Establish justification
- Obtain consent
- Respect maternal wishes
- Consider woman's comfort, dignity and privacy
- Consider analgesia
- Consider cultural, religious and ethical needs
- Palpate abdomen and auscultate FHR
- Position appropriately
- Consider allergies
- Consider ANTT
- Prepare equipment
What equipment is required?
- Adequate lighting
- Sterile lubricating gel
Describe the VE procedure
1. If needed, clean vulva top to bottom
2. Prepare equipment
3. Put on sterile gloves and apply gel to 'clean hand'
4. Use 'dirty hand to hold labia apart and assess
5. Gently insert 2 'clean finger', one at a time, down and back into vagina and assess
6. Assess the cervix once identified
7. Assess the cervix if able to enter
What should be assessed on the labia?
- Lesions, warts, spots, cysts, scars
- PV loss, discharge/ liquor/ blood
- Redness, heat, moisture
- Oedema (swelling)
What should be assessed in the vagina?
- Muscle tone of vagina and pelvic floor
- Dryness and excess heat - signs of infection
What should be assessed for at the cervix?
- Length/ effacement
- Application to presenting part
- Abnormalities (e.g. oedema)
What should be assessed inside the cervix?
- Presence/ absence of membranes
- Station of presenting part
- Position of foetus
- Flexion/ attitude of head
- Presence of caput or moulding
- Abnormalities (e.g. presence of cord/ placenta)
What is the station of the presenting part in relation to?
What do anterior and posterior refer to?
Anterior = towards mum's head
Posterior = towards mum's feet
What are the 8 main positions?
1. LOA (left occipitoanterior)
2. LOP (left occipitoposterior)
3. LOL (left occipitolateral)
4. ROA (right occipitoanterior)
5. ROP (right occipitoposterior)
6. ROL (right occipitolateral)
7. OA (occipitoanterior)
8. OP (occipitoposterior)
What do flexed and deflexed mean?
Flexed = chin to chest
Deflexed = head back
How should station be assessed?
- Same as engagement
- In relation to ischial spines
- Abdominal palpations
What is the difference between assessing engagement and station?
Station = VE
Engagement = palpation
What should be done post examination?
- Auscultate foetal HR
- Ensure comfort and hygiene
- Discuss findings
- Ensure awareness of any pv loss noted
- Record keeping
- Plan of care