SPECIFIC TEACHING

OBJECTIVE TIME CONTENT LEARNING AV AIDS EVALUATION

ACTIVITY

Introduce the 2 mins INTRODUCTION: Student teacher

topic Vaginal examination has become a routine explaining and the
procedure in labour. Dixon & Foureur (2010) state students are
that vaginal examinations are arguably considered listening.
to be both an intervention and an essential clinical
assessment tool in labour.

A vaginal examination is an essential part of

midwifery care, and is routinely performed when
assessing the progress of labour. As evidences
shows that women may find it unpleasant,
embarssing and sometimes painful.

Define vaginal 2 mins DEFINITION: Student teacher

examination. Vaginal examination is the examination done per defining the vaginal What is vaginal
vagina to detect the status of the vagina and examination and examination?
cervix, and to assess the progress of labour and students are
the presenting fetal part descends through the birth listening.
canal.
 SPECIFIC TEACHING
OBJECTIVE TIME CONTENT LEARNING AV AIDS EVALUATION
ACTIVITY

List down the 5 mins INDICATIONS: Student teacher

indications for Whatever aseptic technique is employed, there is explaining about the
vaginal always some chance of introducing infection indications of
examination. especially after rupture of the membranes. Hence vaginal examination
vaginal examinations should be restricted to a and students are
minimum. listening.
 At the onset of labour – to confirm the
onset of labour and to detect precisely the
presenting part and its position.
 Progress of labour – to note the dilatation
of cervix and descent of vertex and
buttocks in relation to spines (station).
 Following the rupture of membranes –
to exclude cord prolapse specially where
the head is not yet engaged.
 Whenever any interference is
contemplated..
 To confirm the actual coincidence of
bearing down efforts with complete
dilatation of the cervix.
 To diagnose precisely the beginning of 2nd
stage of labour
 SPECIFIC TEACHING
OBJECTIVE TIME CONTENT LEARNING AV AIDS EVALUATION
ACTIVITY

Explain the 5 mins PURPOSES OF A PELVIC EXAMINATION: Student teacher

purposes the  To make a positive diagnosis of labour. explaining the
pelvic  To monitor cervical dilatation and purposes of vaginal
examination effacement. examination
 To make a positive identification of the
fetal presentation.
 To ascertain whether forewater have
ruptured or to rupture them artificially.
 To determine if cord prolapse is likely to
occur.
 To exclude cord prolapse after the rupture
of forewaters.
 To assess the progress or delay in labour.
 To detect whether second stage has begun.
 To assess status of head and degree of
moulding.
 To apply fetal scalp electrode.
 To determine if presenting part is engaged
or not.
Under no circumstances should a midwife
make a vaginal examination if there is any
frank bleeding.
GENERAL INSTRUCTIONS:
 The bladder should be empty.
 The fingers should not be withdrawn until
the required information has been
obtained.
 Perineal care should be given before
performing vaginal examination.
 It should be restricted or limited after
membranes have ruptured.
 It should be avoided in case of antepartum
haemorrhage.
 The vaginal examination is to be carried
out at least once 4 hours during the first
stage of labour and after rupture of the
membranes and findings recorded in the
partograph.
 The internal examination should be gentle,
thorough and the methodological using the
aseptic technique.
 Once the sterilized gloved fingers are
taken out after vaginal examination, they
must not be reintroduced under any
circumstances.
Explain the 2 mins ARTICLES REQUIRED:
articles required
fo the procedure ARTICLE RATIONALE
 Cap To prevent infection
 Gloves and standard
 Plastic apron precautions. Student teacher
 Mask enlist the
 Shoe cover preparation of the
 Lubricating jelly For lubricating the environment, mother
fingers. and the articles.
 Drawsheet sterile To prevent soiling of
bed linen.
 Betadiene solution To prevent infection
and to clean the
perineum
 Sterile vulval pad To put over the
perineum.
 Sterile sponge To clean the
forceps perineum.
 Swabs To clean the
perineum.
 Mackintosh To avoid soiling of
bed linen.
Demonstrate the 15 mins PRE PROCEDURAL STEPS:
procedure Physical preparation:
 Provide loose gown for the mother to
wear.
 Shave the perineum/trim the hair as per the
policy of the hospital during the first stage
of labour.
 Bladder should be empty.
  Provide perineal care to the patient.
 Provide comfortable position (lithotomy
position).
Psychological preparation:
 Explain the procedure, its steps to the
patient and its purposes.
 The procedure can be stopped at any time,
if she has any problem.
 Deep breathing during the procedure.
 Relax the abdominal and perineal muscles.
 Explain various experiences (pain and
discomfort), expected during the
procedure.
 Assure patient that she will be provided
privacy while performing the procedure.

INTRAPROCEDURAL STEPS:
NURSING ACTION RATIONALE
Wear cap, mask and Prevents infection and
plastic apron. standard precaution.

Explain the procedure Promotes compliance.

to the mother.

Ask mother to void if

the bladder is not Avoids discomfort
empty. during procedure

Explain how she

should relax during For smooth and safe
the examination. performance of the
procedure.
Read the chart for
previous findings. Serves as a baseline
data.
Ask the patient to lie
down in dorsal For good
recumbent position visualization.
with the knees flexed
at the edge of the
examination table.

Drape the patient. Provides privacy.

Do a surgical hand Prevents the spread of

washing. infection to mother
and fetus.

Don sterile gloves.

Observe the external The external genitalia

genitalia for the must be observed
following: before cleansing the
 Signs of vulva to rule out any
varicosities, abnormality.
edema, vulval
warts or sores.
 Scar from
previous
episiotomy or
laceration.
 Discharge or
 bleeding from
vaginal orifice.
 Colour and
odour of
amniotic fluid,
if membranes
have rupture.
Clean the vulva and
perineum with
antiseptic solution.

Dip the first two Lubricate the fingers.

fingers of the right
hand into the
antiseptic cream.

Holding the labia apart

with thumb and index
fingers of left hand,
insert the lubricated
fingers into vagina,
palm side down,
pressing downwards.

With the fingers Touching clitoris

inside, explore the causes discomfort and
vagina for required anus causes
information taking contamination.
care not to touch the
clitoris or anus.
Note the following: Normally vagina is
 The feel on the warm and moist. Hot
touch of the dry vagina is a sign of
vaginal walls. obstructed labour.
 Consistency of Hot vagina is seen in
the vaginal maternal fever. Firm
walls. and rigid walls suggest
 Scar from long labour.
previous Normal finding is soft
perineal vaginal walls.
wound,
cystocele or
rectocele.
 Normally cervix is
Examine the cervix situated centrally.
with the fingers in the In early labour cervix
vagina turned is situated posteriorly.
upwards. Locate the
cervical os by
sweeping the fingers
from side to side.

Assess cervix for:

 Effacement Thinning/taking up of
the cervix and
shortening of the canal
indicates
effacement(0-100%)
.
 Dilatation Gaping of the internal
os (0-10 cms).
 Consistency Normal cervix is soft,
 elastic and well
applied to the
presenting part in the
normal labour.

 Position Central or lateral

\
 Forewaters Present or absent.
Intact membranes,
which become tense
during contractions
with well-fitting
presenting part
indicates forewater.
Protruding membranes
are seen with ill fitting
presenting part,
Membranes will not
be felt if the rupture
early.

Assess the level of

presenting part in
relation to maternal
ischial spines.
The distance of the
Identify the presenting part above
presentation (vertex or and below the ischial
breech, face, brow). spine is expressed as
(Cephalic- feeling minus (-) and plus (+)
hard bones of the vault stations respectively.
of the skull, fontanels Eg.: feta head at -2
and sutures. Breech – station refers to a level
scrotum and buttocks of fetal head 2cm bove
is felt). the ischial spines.

Position- in cephalic
presentation the first
Identify the position feature felt is sagittal
by feeling the features suture may be
of the presenting part. left/right oblique
diameter of pelvis or
may be transverse.

If head is flexed well

posterior fontanelle is
With the fingers, felt.
follow the sagittal The location of the
suture to feel the fontanelle in relation
fontanelle. to pelvis, gives
information about the
position of occiput.

The parietal bones

override the occipital
Assess the moulding bone in case of
by feeling the amount moulding.
of overlapping of skull
bones. For comparison with
earlier findings.
At the completion of
the examination,
withdraw fingers from
vagina, take care to
note the presence of
any blood or amniotic
fluid on the examining
fingers.

Transverse diameter
of the outlet – admits
the knucles of the
clinched fist between
the ischial tuberosities.

POST PROCEDURAL STEPS:

 Clean and dry the perineal area and

buttocks.
 Give sterile pad if leakage.
 Remove the gloves and wash hands.
 Auscultate the fetal heart tones.
 Assist the woman to a comfortable
position and inform her progress of labour
– it will encourage mother to relax and
participate in labour.
 Record the findings and observations in
the patients chart and inform the physician
of the observation and progress of labour –
to communicate between the staff
members.
 Soiled cotton and gauze should be
 discarded in yellow bucket.
 Articles should be cleaned and dried.
Replaced to the utility room and send the
P/V tray for autoclaving.

CONCLUSION:
When the examination is finished, the midwife
will be able to judge how the labour is likely to
proceed and the likelihood of any
complications. Continuous assessment and
monitoring throughout the period of labour
and delivery is a very important responsibility
of the midwife.
 SPECIFIC TEACHING
OBJECTIVE TIME CONTENT LEARNING AV AIDS EVALUATION
ACTIVITY

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 NINE. Clinical Nursing procedures.1st
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 Jacob A. Clinical Nursing Procedures:the
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Brothers publishers. New Delhi. Pg. 546-
548.
 Chapman.V, Charles C, “The midwife’s
labour & birth handbook”. Third edition.
Wiley black-well publications, 2013;18-
28.
 Podder lilly,” Obstetrical nursing and
gynaecology” procedure manual, first
edition. CBS publishers& distributors pvt
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 Saxena Richa, “ Bedside Obstetrics &
gynaecology, Jaypee publications,
2010:18-23.
 Marie Elizabeth, “Midwifery for nurses”
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