1 / 34

Pelvic examination

Pelvic examination. Modified by: Dr/Amaal Rayan. To know the indication for pelvic examination To know the technique and value of speculum examination. To know the technique and value of bimanual examination. To know how to do a pap smear and what is its value.

whitney
Download Presentation

Pelvic examination

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Pelvic examination Modified by: Dr/Amaal Rayan

  2. To know the indication for pelvic examination • To know the technique and value of speculum examination. • To know the technique and value of bimanual examination. • To know how to do a pap smear and what is its value. • To know how to examine the vagina during labor. objectives

  3. Check the health of the reproductive organs and to diagnose any problem. • Prescribe and/or fit birth control devices • Check for vaginal infections or STDs (sexual transmitted diseases) • Determine pregnancy or miscarriage • Screen for cervical cancer, which can be treated and cured if found early Indications of pelvic exam

  4. Routine checkup every year • Heavy vaginal discharge that itches, burns or smells • Heavy vaginal bleeding or bleeding between periods • Painful intercourse • Menstrual cramps that cause you to miss school or work • Any signs of pregnancy • Side-effects of birth control When to have a pelvic exam:

  5. 1-PV

  6. Procedure before examination. 􀂃 Obtain her verbal consent 􀂃 Explain that you are about to perform an internal examination of the vagina and the uterus using fingers. 􀂃 Explain to her that it shouldn't be painful and ask her to let you know if there's any pain

  7. Procedures before examination 􀂃 Ask her to empty bladder . 􀂃 Assure privacy and ask for a chaperone . 􀂃 Ask to lie on the couch and undress, waist down 􀂃 Sheet for dignity 􀂃 Position her on back, hips and knees flexed and thighs abducted. 􀂃 Examine abdomen for any mass and be sure bladder is empty.

  8. Examination 1- Inspect external genitalia 􀂃 Hair distribution 􀂃 warts 􀂃 rashes 􀂃 ulcers 􀂃lumps 􀂃 vesicles 􀂃 excoriation

  9. 2- Examination . 􀂃 Ask the patient to cough (urinary incontinence) 􀂃 Ask the patient to bear down (uterine prolapse). .

  10. 3-Gloves then palpate: • Urethral meatus, Labia, Bartholin’s glands and Perineum • 4- Lubricate the right index and middle fingers. • 􀂃 5- Expose introitus by separating labia with thumb and forefinger of gloved left hand • . • 􀂃6- Gently introduce gloved lubricated right index and middle fingers into vagina. • 􀂃 7-Thumb abducted to allow maximum use of length of the index & middle fingers; ring & little fingers flexed into palm.

  11. 8- Palpation: • Palpate anterior ,posterior and lateral walls of vagina ? • obliterated or bulging due to a pelvic swelling mass, cyst or foreign bodies.

  12. 9-Examination of the cervix Normally points downwards and slightly backwards.􀂃 Cervix should feel firm, rounded and smooth. Assess mobility move cervix gently Palpate the fornices. This procedure is painless Tenderness is called “cervical excitation.”

  13. 2-Speculum exam

  14. Explain details of the procedure and gain verbal consent • Ask the patient to empty her bladder • Allocate a separate private area for the patient to undress. • Chaperone should always be present. Preparation

  15. Gloves • Speculum • Lubricating jelly • Examination couch and a ‘modesty sheet’ • Adequate lighting • Ensure speculum is warmed and all equipment is in working order Equipment

  16. Inspection • Hair distribution • Vulval skin • Look at the perineum for scars/tears • Gently part labia – inspect urethra • Look for discharge, prolapse, ulcers, warts

  17. Visualisation of Cervix • Inspect for: • Discharge • Warts • Tumours • Size of cervical os • Bleeding

  18. Ask the patient to cough: • Rectocele • Cystocele • Liquor Findings

  19. Taking a Cervical Smear

  20. Women are invited to have routine smears performed every 1-3 years • Needs to be done in the mid-late follicular phase and NOT during menstruation • Worldwide- cancer cervix second most common malignancy Indications of cervical smear

  21. Following insertion of bivalve speculum • Equipment: • Aylesbury spatula • Confirm name, hospital number etc • Label frosted end of slide • Explain that the procedure may be uncomfortable Taking a cervical smear( technique)

  22. Taking a Cervical smear( technique) • Rest point of spatula within the os and rotate clockwise 360° then rotate 360° anti-clockwise. • Exert light pressure (pencil). • Ensure contact with cervix throughout.

  23. Spread both sides of the spatula onto the slide. • Place immediately into the fixative for between 10 – 90 mins. • High-risk specimens should be left in for a minimum of 1 hour. • Inform the patient how long the results will take and how they will be delivered. Concluding Cervical Smear

  24. 3-Bimanual examination

  25. BimanualExamination • Separate labia with gloved left hand • Inserted index finger into vagina then slowly insert middle finger to palpate cervix • Left hand then palpates uterus abdominally

  26. Tips of the vaginal fingers placed into each lateral fornix and the adnexae are examined on each side • The uterosacral ligaments can be felt in posterior fornix

  27. 4-Examination during labor

  28. Palpate uterine contractions • Assessment of the cervix dilatation • 1 finger  1-2 cm dilated • 2 fingers  3-4 cms dilated • 3 fingers  5-6 cms dilated • 4 fingers  7-10 cms dilates Examination during labor

  29. 3. Effacement of the cervix: thinning of the cervix (%) or length (cm). The cervix is normally 3-5 cms. If cervix is about 2 cm from external to internal os  50% effaced 50% effaced 100% effaced

  30. 4. Consistency of the cervix: soft vs. hard. During labor the cervix becomes soft. 5. Position of the cervix: posterior vs. anterior. During labor the cervix changes from posterior to anterior. 6. Membrane is intact or ruptured: assessed by fluid collection in the vagina

  31. Thank you

More Related