Vaginal Exam (VE) & Bimanual Palpation

Last updated 20.09.12

 

Definition

-  Manual exmaination of vagina & palpation of internal female genital organs (cervix, adnexa, ovaries, uterus)

 

Features

-  Part of Gynaecological & Obstetric Examinations

-  Always use chaperone for medicolegal purposes

-  Ensure adequate privacy

 

Indications

-  Bimanual palpation should precede

-  Pap smear

-  Mirena insertion

-  Pelvic pain

-  VE used to determine cervical dilation & effecement in pregnancy

-  Should not be done unless location of placenta is known & placenta praevia excluded

-  Bishop score

-  Stage of labour

-  Progress of labour

-  Labour dystocia

-  Obstructed labour

-  Prolapse: POP-Q

 

Patient

-  Supine +/- lithotomy

-  Knees & hips flexed

-  Ankles together & legs abducted

 

Equipment

-  Drape/bluey

-  Lubricant

-  Sterile gloves

 

Procedure

-  Explanation & patient consent

-  Chaperone

-  Palpate abdomen prior

-  Palpation of gravid uterus

-  General abdominal exam

-  Sterile gloves w lubricant

-  Vaginal Examination (VE)

-  Insert right index & middle fingers into vagina with palm up

-  Be careful not to press on clitoris with right thumb

-  Roll left hand supeior to pubic symphysis to feel for fundus of uterus

-  Palpate cervix & assess for

-  +/- POP-Q for prolapse

-  Bishops score

-  Cervical dilation: open vs closed, number of cm (0-10cm)

-   1 finger = 1cm

-   2 fingers = 2-3cm

-   Then spread fingers & estimate

-   Multi os = dilation w some effacement felt as a small canal

-  Cervical length (cm): long, short

-  Cervical consistency: firm, average, soft

-  Cervical position: posterior, anterior, mid

-  Fetal station (relative to ischail spines)

-   Ischial spine = 1

-   -4 (away from) to +4cm (past) from spines

-  Membranes intact: SROM, PPROM

-  Presenting part

-   Position

-  Most relevant at full dilation

-  Palpate sagital suture & run post/ant

-  +/- feel for ear

-  +/- US

-   Moulding: overlapping of sutures, rated x/3

-  Parietal bones overlap occipital, ant. parietal bone overlaps post parietal

-  0 = separate

-  1 = meeting

-  2 = overlapping but reducible

-  3 = overlapping & not reducible

-   Caput

-  Usually 3/3 moulding

-  +/- then progress to bimanual exam

 

Station

 

-  Bimanual Exmaination

-  Gently pulse cervix if needed to feel uterus

-  Cervical motion tenderness: PID

-  Change direction of pressure to lateral sides to palpate ovaries/adnexa

-  Tenderness or mass: ectopic, ovarian cysts, tubo-ovarian abscess (PID)

-  Body of retroverted uterus may be felt in posterior fornix, not via abdomen

 

 

 

References

 

Pic (Station)