Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur
COLLEGE OF HEALTH SCIENCES

Name of Student: Date:

Year and Section: Grade:

PROCEDURE CHECKLIST: VAGINAL EXAMINATION (for WOMEN IN

LABOR)

Instruction: Below is the grading scale which will be used in rating your
performance.
5 - Excellent - 96 – 100
4 - Very Satisfactory - 91 – 95
3 - Satisfactory - 86 - 90
2 - Fair - 81 - 85
1 - Needs Improvement - 75 – 80

INTRODUCTION:

VAGINAL EXAMINATION IS A SYSTEMATIC STERILE PROCEDURE

PERFORM ON A WOMAN THROUGH THE VAGINA. VAGINAL EXAMINATION IS
USED TO INVESTIGATE THE FEMALE GENITAL TRACT. IT IS A FUNDAMENTAL
INVESTIGATION IN GYNAECOLOGY AND IS PAINLESS IN PRINCIPLE. THE
EXAMINATION CAN BE PERFORMED EITHER BY
A VAGINAL EXAMINATION IS USED TO DIAGNOSE AN ABNORMAL POSITION OR
INCREASE IN SIZE OF THE UTERUS. A MASS CAN BE EASILY DETECTED BY
THE PRACTITIONER'S HAND. THE PRACTITIONER CAN ALSO ENSURE THAT NO
OVARIAN CYSTS ARE PRESENT DURING THE EXAMINATION. THIS
EXAMINATION CAN ALSO REVEAL AN INCREASE IN VOLUME OR ABNORMAL
CONSISTENCY OF THE CERVIX.

ASSESSMENT:
1. Identify the patient, assess the patient’s ability to cooperate and
relax.
2. Discuss the procedure and it’s importance.
3. Assess the progress of labor.
PLANNING:
 1. Check the client’s condition and understanding.
2. Discuss the procedure to the client.
3. Ask for permission from the client before doing the procedure.
4. Ask for assistance if necessary.

Assemble equipment:

1.STERILE GLOVES
2. LUBRICANT (KY GEL)
3. PAPER TOWELS
4. LIGHT

PREPARATION 543 2 1 REMARKS

KNOWLEDGE:
1. Defines vaginal examination.
2. Discuss the purposes of vaginal To assess the progress and delay
examination in labor of labor
3. Enumerate the equipment used in
vaginal examination
4. Enumerates factors affecting the need
for vaginal examination.
5. states the rationale for each step.
SKILLS:
PROCEDURE
PART – A. PREPARATION
1. Introduction of self/Identification of 1. build trusting nurse-client
client. relationship
2.Performs handwashing before and after 2.handwashing helps prevent the
the procedure spread of microorganisms.
3. Prepare the client. 3. a. explanations ensure patient
a. Tell the patient you are going Cooperation and compliance.
to examine the vagina and ask if d. privacy enhances self-esteem
they’re still ok for you to do so.
b. explain the procedure to the client
c. Assess the client status. e. positioning in this manner
d. provide privacy by draping the client allows for good visualization of
appropriately the perineum.
e. assist the client in positioning
correctly; The patient lies on her back
on an examination table with her thighs
and legs apart and her heels in stirrups
DORSAL
RECUMBENT/LITHOTOMY
POSITION.
f. wash the perineal area
g. pat it dry
 h. applies antiseptic solution over the
vulva
PART - B. VAGINAL
EXAMINATION
4. Assembles the equipment, including
sterile examining gloves, sterile
lubricant, and gauze squares. needed
5.If the patient consents to the
continuation of the examination:
a. put on sterile glove
b. Lubricate By discarding a drop of
the lubricating gel at the gloved index
and middle fingers of your dominant
hand .
c. Carefully separate the labia using the
thumb and index finger of your non-
dominant hand. Inspect the external
genitalia for lesions.
d. look for escaping amniotic fluid or
the presence of umbilical cord
e. if the umbilical cord or bleeding is
not noted,
Gently insert the gloved index and mid
dle finger of your dominant hand into
the vagina. directing them towards the
posterior vaginal wall.
f. Instruct to take a deep breath or open
mouth while inserting the fingers.
g. Enter the vagina with your palm
facing laterally and then rotate 90
degrees so that your is facing upward.
6. Touch the cervix with your gloved
fingers.
a.Palpate for cervical consistency,
position and rate if firm or soft
b. Measure the extent of dilation
c. Palpate for anterior rim or lip of
cervix is present
d. Estimate the degree of effacement
4. Organization and planning
improve efficiency.
5. a. use of a sterile gloves
prevents contamination of the
birth canal.
b. discarding a drop of lubricant
ensures quantity used will not be
contaminated.
c. presence of any lesions may
indicate an infection and may
possibly vaginal birth
d. and e. amniotic fluid implies
membranes have ruptured and the
umbilical cord may have
prolapsed.
e. Bleeding may be a sign of
placenta previa. Vaginal
examination should not be
continued if a possible placenta
previa exists.
The posterior vaginal wall is less
sensitive than the anterior wall
6.a. the cervix feels like a circular
rim of tissue around a center
depression. If firm, it feels
similar to the tip of a nose; if soft,
it is as pliable as an earlobe.
b. an index finger averages about
1 cm; a middle finger about 1.5
cm. if they can both enter the
cervix, the cervix is dilated 2.5 -
3cm. If there would be room for
double the width of two
fingertips, dilatation is complete
at 10 cm
d.effacement- Normally, your
cervix is closed, firm, and

e. Estimate membrane are intact
7. Locate the ischial spine
a. Rate the station of the presenting
part
b.. Identify the presenting part
c.. Establish the fetal position
d. With draw hand
e. Wipe the perineum from front to
back to remove the secretions or
examining solution/lubricant.
f. Thank the patient for cooperating.
elongated (before labor between
3.5 and 4 centimeters long/in our
textbook it is 2-2.5 thickness).
When you go into labor, the
cervix thins out and becomes
softer and shorter. – effacement is
estimated in a percentage
depending on thickness. If it is
only 1cm thick, it is 50% effaced.
If it is tissue paper thin, it is
100% effaced. With 100%
effaced cervix, dilatation is
difficult to feel because the edges
of the cervix are so thin.
e. The membrane (with slight
amount of amniotic fluid in front
of the presenting) assume the
shape of a watch crystal. With a
contraction, they bulge forward,
become prominent, and can be
felt much more readily.
7. ischial spine are palpated as
notches at the 4 and 8 o’clock
positions of the pelvic outlet.
a. Station is the number of
centimeters above or below the
spines the presenting fetal part
has reached.
b. Identifying the presenting part
confirms findings obtained with
leopold maneuvers. The vertex
has a hard, smooth feel. Fetal hair
may be palpable but massed
together and wet, and it may be
difficult to appreciate through
gloves. Palpating the two
fontanelles, one diamond-shaped
and the other triangular, helps
identification. Buttocks feel
softer and give under fingertip
pressure. Identifying the anus
may be possible because the
sphincter action will “trap” an
examining finger.
c.The fontanelle palpated is
 g. Leave the client comfortable and
turned to side or sit up.
invariably the posterior one
because the fetus maintains a
flexed position, presenting the
posterior and not the anterior
fontanelle. If it points toward an
anterior quadrant, the position is
ROA or LOA. In breech
presentation, the anus can serve
as a marker for position.

e. wiping front to back prevents

moving rectal contamination
forward to the vagina.

g. side lying or sitting helps

prevent supine hypotension
syndrome.

7. Dispose of PPE appropriately

and wash your hands.
8. Summarize your findings.
9. Document the examination in the
medical notes including the details of 9. Documentation provides a
the relatives means for communication and
evaluation of care and patient
outcomes.

ATTITUDE:
1. Performs the procedure in a relaxed,
systematic manner
2. Willingly accepts criticisms well and
shows effort to improve
3. Answers questions politely and tactfully.
4. Observes proper decorum as a mature
student nurse
5. Saves time and effort in performing the
procedure
6. Well- groomed and neat
7. Reports to the study areas promptly and
on time
Has initiative, is resourceful and uses
time creatively

Date/Time: ___________________________
Printed name & Signature of C.I. ____________________________