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Thread: Tips on - Performing a Speculum Examination

  1. #1
    trimurtulu is offline MedicalGeek Resident
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    Arrow Tips on - Performing a Speculum Examination

    Tips on - Performing a speculum examination


    A vaginal examination is a very intimate and personal examination. It’s also an essential skill for medical students doing obstetrics and gynaecology. Here’s a look at how to make sure that all goes smoothly.

    Before you start


    •Introduce yourself, explain what you are going to do and why

    •Check if the patient is pregnant

    •Get verbal consent

    •Make sure you are in a private room, and the patient is comfortable

    •Ask the patient to empty her bladder

    •Offer a chaperone

    •Get all the necessary equipment ready, in the order you will need it (if you are taking a smear, label the slide in pencil)

    •Warm and lubricate the speculum by holding it under running warm water. When performing the examination

    •Inspect and palpate the abdomen for any obvious masses. Then ask the patient to bend her knees and flop her legs apart

    •Perform a bimanual examination to feel the size and position of the uterus, any ovarian masses, and feel the position and consistency of the cervix (omit this if the patient is more than 20 weeks’ pregnant)

    •Inspect the labia and introitus, and warn the patient you are about to insert the speculum

    •Part the labia using your index and middle finger of your non-dominant hand

    •Insert a Cuscoe’s speculum right up to the cervix and open the blades until you see the cervix (it looks like a doughnut). Avoid plastic speculums if the patient is obese

    •Comment on the appearance of the cervix, and take triple swabs for chlamydia, gonorrhoea, and other bacteria

    •If appropriate, take a smear from the cervical os using an Ayre’s spatula

    •Withdraw the speculum steadily with the blades open, rotating the speculum to 45 degrees; it may be easier if you ask the patient to cough at the same time

    •If the patient has uterine prolapse, you may need to examine her using a Sim’s speculum, with the patient in the left lateral position (as for a digital rectal examination) After the examination

    •Let the patient get dressed

    •Explain your findings to the patient

    •If you have taken a smear, fix it with solution as soon as possible and send to the lab

    •Label any swabs and send them off to microbiology.


    -------------


    Sterile Speculum Exam Policy and Procedure


    DEFINITION AND PURPOSE:

    The sterile speculum exam is used to assist the practitioner to determine if amniotic membranes have ruptured.

    Amniotic fluid contains a high amount of a salt called sodium chloride. If drops of the fluid are spread on a glass slide, allowed to dry, and examined through a microscope, a characteristic palm leaf pattern can be seen. This is why it is sometimes called “arborization” or the fern test.


    More Details:



    [HIDE]
    http://www.marchofdimes.com/prematurity/Procedures1.pdf
    [/HIDE]

    Watch Vidio


    [HIDE]
    http://www.youtube.com/watch?v=CQykb...eature=related
    [/HIDE]
    Last edited by trimurtulu; 11-28-2008 at 04:03 PM.

  2. #2
    trimurtulu is offline MedicalGeek Resident
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    How To Perform Vaginal Self Exam


    Vaginal and cervical self-exams help women learn what is normal, allowing women to more quickly recognize changes. Vaginal self exam does not replace your annual professional pelvic exam.


    Here's How:

    You will need a strong light such as a flashlight, a mirror, a vaginal lubricant, antiseptic soap or alcohol, and a plastic speculum (get a speculum from a pharmacy that sells medical supplies).


    1. Find a place to relax. This can be the floor or your couch, wherever you can feel comfortable.

    2. Lie back.

    3. Bend your knees, with your feet wide apart.

    4. Lubricate the speculum, and insert it into your vagina in the closed position. Experiment to find the most comfortable position for inserting the speculum.

    5. Once the speculum is inserted, grab the shorter section of the handle and firmly pull it toward you until it opens inside your vagina.

    6. Push down on the outside section until you hear a click, while keeping a firm hold on the speculum. The speculum is now locked in place.

    7. Place the mirror at your feet so that you can see your vagina. Move the speculum, while shining the flashlight into the mirror, until you can see your cervix and vaginal walls in the mirror.

    8. Take note of the color of your cervix, as well as any vaginal secretions.

    9. Remove the speculum, after your examination is complete, either in the closed or open position whichever is most comfortable for you.

    10. Thoroughly wash the speculum with antiseptic soap or alcohol and store for your next self exam.


    Tips:

    1. Speculums are available at pharmacies that sell medical supplies.

    2. Some women may find it easier to have a friend or partner help by holding the mirror. The normal cervix appears wet, pinkish, and has a bulb shape. The cervix of pregnant women has a bluish tint.

    3. Vaginal secretions change through out the month. Understanding the changes your body goes through can help you detect your fertile periods, as well as abnormalities.

    What You Need:

    plastic speculum

    flashlight

    mirror

    vaginal lubricant

    antiseptic soap or alcoho


    -------------


    The Myth of a Vaginal Exam


    Vaginal exams. I don't know a single woman who likes them.

    However, there is a myth perpetuated in our society that vaginal exams at the end of pregnancy are beneficial. The common belief is that by doing a vaginal exam one can tell that labor will begin soon. This is not the case.
    Most practitioners will do an initial vaginal exam at the beginning of pregnancy to do a pap smear, and other testing. Then they don't do any until about the 36 week mark, unless complications arise that call for further testing or to assess the cervix. If your practitioner wants to do a vaginal exam at every visit, you should probably question them as to why.

    Vaginal exams can measure certain things:


    Dilation: How far your cervix has opened. 10 centimeters being the widest.


    Ripeness: The consistency of your cervix. It starts out being firm like the tip of your nose, softening to what your ear lobe feels like and eventually feeling like the inside of your cheek.


    Effacement: This is how thin your cervix is. If you think of your cervix as funnel-like, and measuring about 2 inches, you will see that 50% effaced means that your cervix is now about 1 inch in length. As the cervix softens and dilates the length decreases as well.


    Station: This is the position of the baby in relation to your pelvis, measured in pluses and minuses. A baby who is at 0 station is said to be engaged, while a baby in the negative numbers is said to be floating. The positive numbers are the way out!


    Position of the baby: By feeling the suture lines on the skull of the baby, where the four plates of bone haven't fused yet, one can tell you which direction the baby is facing because the anterior and posterior fontanels (soft spots) are shaped differently.


    Position of the cervix: The cervix will move from being more posterior to anterior. Many women can tell when the cervix begins to move around because when a vaginal exam is performed it no longer feels like the cervix is located near her tonsils.


    What this equation leaves to be desired is something that is not always tangible. Many people try to use the information that is gathered from a vaginal exam to predict things like when labor will begin or if the baby will fit through the pelvis. A vaginal exam simply cannot measure these things.
    Labor is not simply about a cervix that has dilated, softened or anything else.

    A woman can be very dilated and not have her baby before her due date or even near her due date. I've personally had women who were 6 centimeters dilated for weeks. Then there is the sad woman who calls me to say that her cervix is high and tight, she's been told that this baby isn't coming for awhile, only to be at her side as she gives birth within 24 hours. Vaginal exams are just not good predictors of when labor will start.


    Using a vaginal exam to predict advisability for a vaginal birth is usually not very accurate, for several reasons. First of all it leaves out the factor of labor and positioning. During labor it's natural for the baby's head to mold and the mother's pelvis to move. If done in early pregnancy it also removes the knowledge of what hormones like Relaxin will do to help make the pelvis, a moveable structure, be flexible. The only real exception to this is in the case of a very oddly structured pelvis. For example, a mother who was in a car accident and suffered a shattered pelvis or someone who might have a specific bone problem, which is more commonly seen where there is improper nutrition during the growing years.


    During labor vaginal exams can't tell you exactly how close you are either, so keeping them to a minimum then is also a good idea, particularly if your membranes have ruptured.

    Okay, so there's not really a great reason to have a vaginal in exam done routinely for most women.



    So are there any reasons not to have vaginal exams?

    There sure are.

    Vaginal exams can increase the risks of infection, even when done carefully and with sterile gloves, etc. It pushes the normal bacteria found in the vagina upwards towards the cervix. There is also increased risk of rupturing the membranes. Some practitioners routinely do what is called stripping the membranes, which simply separates the bag of waters from the cervix. The thought behind this is that it will stimulate the production of prostaglandins to help labor begin and irritate the cervix causing it to contract. This has not been shown to be effective for everyone and does have the aforementioned risks.


    In the end only you and your practitioner can decide what is right for your care in pregnancy. Some women refuse vaginal exams altogether, so request to have them done only after 40 weeks, or every other week or whatever she feels comfortable with.

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    djskoo is offline MedicalGeek Verified
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    Default thx

    thx for those

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    lionaleem1 is offline MedicalGeek Verified
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    thankyou

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