AIMS

• To assess and evaluate pelvic organs
• To help in making diagnosis e.g ruptured ectopic pregnancy
• As a pre requisite in procedures such as IUCD insertion and MVA
• For collection of specimen

Preparation

• Explains procedure to client and gain consent
• Provides privacy
• Wash hands, observe aseptic technique
• Position in prone position with knees flexed
• Provide good source of light.
• Expose the vulva and abdomen.
• Ensure instruments needed are ready

➢ Trolley

➢ Lubricant

➢ Cuscos vaginal speculum

➢ Sim’s vaginal speculum

➢ Swabs, galli pot

➢ Sponge holding forcep

➢ Sterile water

Steps

It involves the following steps:

• Inspection
• Bimanual examination – V.E.
• Speculum examination
• Rectal examination

1. Inspection: inspect the vulva for scar, tear, discharge, lesions, ulcers, sores.

• Ask woman to cough – to observe bulging e.g. urethrocele, rectocele, cystocele.
• Also observe for leaking of urine.

2. Bimanual examination: through V.E. and abdominal palpation to assess vagina, cervix, position of cervix, consistency, whether open or closed, laceration, mass/growth, position of uterus.

• Place abdominal hand on lower abdomen above symphysis pubis and exert downward pressure.
• Insert two gloved fingers gently into vagina.
• Use vaginal finger to quickly palpate the fornices for any mass, feel whether cervix is open or closed.
• For assessing position of uterus, use fingers in the vagina (in front) to lift the cervix towards the abdominal hand to feel whether the uterus can be felt between two hands.
• If felt, the uterus is in the anterior position.
• If not felt, place vaginal fingers behind cervix and lift uterus towards abdominal hand. If felt, uterus is mid position.
• If uterus is not felt by both techniques, the uterus is retroverted i.e. in posterior position.
• With vaginal and abdominal fingers, feel for tenderness, swelling, thickening etc.

3. Speculum examination

• This is done to visualize the vagina and cervix and to take specimen.
• Inform client of insertion of speculum.
• Lubricate speculum but use sterile water if specimen is to be collected.
• Insert closed speculum obliquely into vagina. Avoid pressure to clitoris and urethra.
• Do not catch skin or hair.
• ½ way, turn speculum horizontally towards cervix.
• Put downward pressure (if Sim’s speculum)
• Secure the speculum (if Cuscos)
• Visualize cervix and vagina for color, growth.
• Collect specimen for cervix using non-touch technique (if indicated).
• Carry out concurrent procedure (e.g. IUD insertion or MVA).
• Unsecure, close and remove speculum gently as inserted.

4. Rectal examination

• Wear sterile gloves
• Lubricate index finger
• Insert index finger gently through the anus to the rectum
• Gently but palpate to feel for any pelvic abnormalities
• Withdraw finger
• Dispose soiled gloves
• Clean patient and make comfortable.
• Document findings and inform patient of findings.
• Dispose used materials according to protocol and decontaminate and sterilize used instruments

OBJECTIVES: PELVIC EXAMINATION/ OBSTETRIC PROCEDURES

1. Pelvic examination is a perquisite to the following procedures EXCEPT

a. Manual vacuum aspiration

b. Insertion of IUCD

c. The use of hormonal contraceptives

d. Vacuum extraction

2. Pelvic examination can assist in the diagnosis of the following EXCEPT

a. Pregnancy

b. Ectopic pregnancy

c. Placenta previa

d. Pelvic tumor

3. The steps in pelvic examination are

a. Inspection, bimanual examination, speculum examination and rectal examination

b. Inspection, abdominal examination, speculum examination and rectal examination

c. Bimanual examination, speculum examination, inspection , rectal examination

d. Vaginal examination, speculum examination and rectal examination

4. Abnormalities that can be detected through inspection duringpelvic examination include

a. Uterine cancer, ovarian cyst and incompetent cervix

b. Urethrocele, VVF, RVF and cystocele

c. Uterine enlargement, ectopic pregnancy and molar pregnancy

d. Ruptured uterus, placenta previa, and ovarian cyst

5. During rectal examination, …………………………………. Inserted  into the rectum to palpate abnormalities

a. Index and middle fingers are

b. Index finger is

c. Rectal dilator is

d. An enema tube

6. Before MVA, pelvic examination is carried out to ascertain……………………………….……………………………….

a. Position and size of the uterus

b. Height of fundus

c. The amount of bleeding

d. He depth of the fornices

 

ANSWER TRUE OR FALSE

7. The uterine sound is used to measure the width of the uterus

TRUE/ FALSE

8. During MVA, the canulla can be used to dilate the cervical os

TRUE/ FALSE

9. MVA can also be used to evacuate hydatidiform more

TRUE/ FALSE

10. If the uterus is not felt during bimanual examination, the position of the uterus is anterior

TRUE/ FALSE

 

MARKING GUIDE

1. D

2. C

3. A

4. B

5. B

6. A

7. FALSE

8. TRUE

9. TRUE

10. FALSE