A vaginal examination is a clinical procedure used to assess the female reproductive organs, especially during pregnancy, labor, or when investigating gynecological symptoms. It includes both speculum and bimanual examinations, and must always be performed with informed consent, privacy, and sensitivity.
Definition
It is the examination done per vagina to detect the status of the vagina and cervix, and to assess the progress of labor as the fetal presenting part descends through the birth canal.
Purposes for Vaginal Examination
- To make a positive diagnosis of labor.
- To monitor cervical dilatation and effacement.
- To make a positive identification of the fetal presentation.
- To ascertain whether forewater have ruptured.
- To determine if cord prolapse is likely to occur.
- To assess the progress or delay in labor.
- To detect whether second stage has begun.
- To assess status of head and degree of molding.
- To apply fetal scalp electrode.
Equipment
A sterile tray containing:
- Sterile cotton balls to give perineal care.
- Artery clamp.
- Bowl with antiseptic solution.
- Sim’s vaginal speculum.
- Sterile cream in a bowl for lubrication.
- Sterile gloves (outside the tray).
Procedure
| Nursing actions | Rationale | |
| 1. | Before procedure Explain procedure to mother. | Promotes compliance. |
| 2. | Ask mother to void if the bladder is not empty. | Avoids discomfort during procedure. |
| 3. | Explain how she should relax during the examination. | For smooth and safe performance of the procedure. |
| 4. | Read the chart for previous findings. | Serves as a baseline data. |
| 5. | Position the women in dorsal recumbent position with knees flexed. | For good visualization. |
| 6. | Drape the patient. | Provides privacy. |
| 7. | During procedure Do a surgical hand washing. | Prevents spread of infection from hands to the mother and fetus. |
| 8. | Don sterile gloves. | |
| 9. | Observe the external genitalia for the following: Signs of varicosities, edema, vulval warts or sores. Scar from previous episiotomy or laceration. Discharge or bleeding from vaginal orifice.Color and odor of amniotic fluid, if membranes have ruptured. | The external genitalia must be observed before cleansing the vulva. |
| 10. | Cleanse the vulva and perineal area. | Avoids chances of infection. |
| 11. | Dip the first two fingers of the right hand into the antiseptic cream. | Lubricates the fingers. |
| 12. | Holding the labia apart with thumb and index fingers of left hand, insert the lubricated fingers into vagina, palm side down, pressing downwards. | |
| 13. | With the fingers inside, explore the vagina for required information taking care not to touch the clitoris or anus. Note the following: The feel on touch of vaginal walls.Consistency of vaginal wall.Scar from previous perineal wound, cystocele or rectocele. | Touching clitoris causes discomfort and touching anus causes contamination. |
| 14. | Examine the cervix with the fingers in the vagina turned upwards. Locate the cervical os by sweeping the fingers from side to side. Assess the cervix for: Effacement.Dilatation.Consistency.Forewaters. | Normally vagina is warm and moist. Hot dry vagina is a sign of obstructed labor or in maternal fever. Firm and rigid walls suggest long labor. Normal finding is soft vaginal walls. |
| 15. | Assess the level of presenting part in relation to maternal ischial spines. | Normally cervix is situated centrally. In early labor, cervix is situated posteriorly. Thinning of the cervix and shortening of the canal indicates effacement. Enlargement of the external os indicates dilatation. Normal cervix is soft, elastic, and well-applied to the presenting part in normal labor. 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 they rupture early. |
| 16. | Identify the presentation by feeling the hard bones of the vault of the skull, the fontanelle and sutures. | The distance of the presenting part above and below the ischial spines is expressed as minus (-) and plus (+) stations, respectively, e.g. fetal head at-2 (minus two) station refers is a level of fetal head 2 cm above the ischial spines. |
| 17. | Identify the position by feeling the features of the presenting part. | The sagittal suture may be felt in the right, left or transverse diameter of the pelvis in early labor. |
| 18. | With the fingers, follow the sagittal suture to feel the fontanelle. | Posterior fontanelle will be felt in a well-flexed head.Location of the fontanelle in relation to the pelvis will give information about the position. |
| 19. | Assess the molding, by feeling the amount of overlapping of skull bones. | The parietal bones override the occipital bone in case of molding. |
| 20. | 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. | For comparison with the earlier findings. |
| 21. | After procedure Remove gloves and wash hands. | Completes the procedure. |
| 22. | Auscultate the fetal heart tones. | Ensures fetal health status. |
| 23. | Assist the woman to a comfortable position and inform her of the progress of labor. | Encourages mother to relax and participate in labor. |
| 24. | Record the findings and observations in the patient’s chart and inform the physician of the observations and progress of labor. | Acts as a communication between the staff members. |
Special Considerations
- Avoid in suspected ruptured membranes unless necessary
- Use smaller speculum or pediatric size in adolescents or postmenopausal patients
- Be alert for signs of trauma, abuse, or distress
- Always stop immediately if the patient requests
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Annamma Jacob, Manual of Midwifery and Gynaecological Nursing, 4th Edition, 2023, Jaypee Publishers, ISBN: 978-9356961593
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