INDICATIONS FOR VAGINAL EXAMINATION

• Confirming onset of labour
• Assessing progress in labour
• To identify the presentation and position of the baby
• To perform artificial rupture of membranes
• To determine pelvic adequacy in terms of size and shape
• To apply a fetal scalp electrode
• To obtain a fetal blood sample
• To exclude cord prolapse after spontaneous rupture of membranes where there is an ill-fitting presenting part
• To confirm onset of second stage
• To assess favorability of cervix before induction

PREPARATION FOR A VE

• Empty the urinary bladder
• Relieve anxiety by exhaustively explaining the procedure
• Obtain informed consent; verbal or written each time
• Ensure privacy and confidentiality
• Drape the client
• Washed your hands and wear sterile gloves
• Treat the client with dignity and respect at all times
• All vaginal examinations should be preceded by an abdominal palpation
• The patient should be advised that the procedure may become uncomfortable and can request for it to be stopped at any time verbally or non-verbally
• Assemble all equipment required for the procedure: • Apron • Requirements for aseptic vaginal swabbing {surgical gloves, 5 sterile cotton swabs, anti-septic} • Hand washing facility or sanitiser • A lubricant should be available

PROCEDURE OF VE

• Explain the procedure to the woman and obtain consent
• The woman should adopt a semi recumbent position, with her knees bent, ankle together and knees parted
• Gently insert the first two fingers of the examining hand into the vagina, in a downward and backwards direction along the anterior vaginal wall to locate the cervix

During the Examination:

• Discussion should be relevant and free of unnecessary comments
• The patient’s privacy and dignity should continue to be respected
• Attention should be paid to verbal and non-verbal indications of distress from the patient
• A full explanation of the results of the VE shall be provided to the patient in a sensitive manner and documented

It is Mandatory to Comment on Each of the Following Areas During the Examination:

• External Genitalia: Any abnormalities such as varicosities, edema, piercings, warts or signs of infection should be noted
• Vagina: Should feel warm and moist; a full rectum may be felt during the examination and should be commented on
• Cervix: • Dilatation: Should be documented as a whole figure in centimeters • Effacement: Is assessed by the length of the cervix and degree to which it protrudes into the vagina • Position: Should be described as posterior, central or anterior • Consistency: Firm, medium or soft
• Presentation: The identification of landmarks on the presenting part help to confirm presentation. It should be noted how well the presenting part is applied to the cervix and if the presence of a cord or membranes are felt
• Station: This is the distance between the presenting part and the ischial spines in cm. Above the spines will be (–cm) and below the spines should be referred to as (+cm)
• Vaginal Loss: Show, blood, liquor; state the amount, color and odor; (membranes Intact, clear, thin meconium stained, thick meconium stained, offensive, absence of liquor)
• Caput: This should be circled: Present or not present
• Molding: These will be circled upon completion of the vaginal examination and are referenced as follows: 0 = Separated bones, sutures felt easily
  
  • = Bones just touching each other ++ = Overlapping bones, reducible +++ = Severely overlapping bones, non-reducible

Additional Steps:

• The midwife should auscultate the fetal heart with a fetal scope or Doppler and this should be performed pre and post VE
• If the patient is in established labour the findings should be charted on the partogram

CONTRAINDICATIONS TO VAGINAL EXAMINATIONS Vaginal examinations should not be carried out in:

• Patients with ruptured membranes who are not in established labour
• Presence of active herpes in a patient with ruptured membranes unless the patient is in labour
• Antepartum hemorrhage without evidence of placental localization
• Unknown placental localization
• Placenta previa
• Preterm labor under 37/40