Indications for vaginal examination
1. To diagnose labor
2. To assess progress of labor
3. To know if the head is engaged e.g. Obese patient
4. To exclude cord prolapse – Ruptured membranes
5. To confirm presentation and positions – Where there is doubt to insert fetal scalp electrode. To confirm lie, presentation of 2nd twin.
6. To confirm second stage of labor – full dilatation– to ascertain if membranes are still intact. To assess progress or delay of labour.
· Note the Vulva – for signs of infection, oedema or varicose veins warts or sore from tear or episiotomy.
· Perineum – Previous scars
· Drainage of liquor – colour, odour & amount green-meconeum stained. Blood stained – ante partum haemorrhage. golden – Rhesus iso-imunization.
· Vagina – if dry, moist, warm or hot.
· If dry and hot – sign of gross dehydration Normal – soft, moist, warm and dilatable.
· Cervix – soft, thin or thick, thight or loose or oe dematous. Also if the OS is dilating.
· Membranes – Intact or ruptured.
· Presentation –head or buttocks.
· Position of the foetus.
· Level of the presenting part: High up in the brim or low in the cavity.
· Degree of moulding
· Other abnormalities – Prolapse of cord and cord pre sentation, anencephaly and hydrocephaly.
Pelvic adequacy; Ischial spines – can be felt or not if felt informDoctor.
· rectum – full or not
· Sacral promontory – if felt or not.
After that the pubic hair is shaved to prevent infection. Enemal is given to empty the bowel in other to prevent passing of feaces during delivery to stimulate uterine contractions. (This has been abolished in the present era of HIV). Vulva is swabbed and patient should have a bath. She should then change into clean Hospital dress and transferred to the first stage room for further management.
Ante partum hemorrhage