Vaginal Examination

antenatal indications for VE

clinical swaps or membrane sweep

membrane sweep

Sweeps around the cervix w/ finger to separate the amniotic sac from the cervix

what membrane sweep does

releases prostaglandin to help soften/ripen cervix to start labour

intrapartum indications for VE (5)

only when clinically indicated, if unclear whether labour has started, unsure of babys presentation/position, cord prolapse, before ARM/internal monitoring

postnatal indications for VE

swabs or suture (only if necessary)

contraindication to VE (3)

no consent

placenta praevia (low placenta)

active bleeding

Preparation before VE (11)

Explain what it is

Explain rationale

What it involves

Options/alternatives

Possible impacts on birth plan

Consent

Ensure empty bladder

Pelvic palpation 1st

Privacy

Equipment ready

Comfortable position

observations in VE

observe for bleeding, discharge, scars, lesions, swelling

steps to VE

lubricate, seperate labia, insert index/middle finer

what to feel for in VE

Note for vaginal rugae, temperature, and moisture

hot/dry vagina

infection, high temperature

cervical assessment

Position

Consistency

Effacement

Dilation

Presenting part

Station

postion (cervical assessment)

anterior, mid, or posterior

consistency (cervical assessment)

firm, soft, or stretchy (cervix starts firm, softens as labour progresses)

effacement of the cervix

Shortening and thinning of cervix measured in percentages (0, 25, 50, 75, 90 and 100%)

Dilation of the cervix

the expansion/stretching of the cervix during labour, measured between contractions

presenting part

what part of baby is felt in the cervix

station/descent of cervix

how far baby's head as descended into maternal pelvis

attitude

flexed/deflexed

Caput succedaneum

common/harmless and temp soft/puffy swelling on newborns scalp due to pressure during vaginal birth ("conehead")

moulding

temp overlapping of fetal skull bones, moulded during labour to help fit through birth canal

After VE (3)

immediate FHR check

communicate findings

documentation