Vaginal Exam VE

A sterile speculum exam if:

■ Suspect rupture of membranes

■ Preterm labor

■ Signs of placenta previa

Otherwise, a digital VE may be performed The following must be assessed:

Status of Amniotic Fluid and Membranes

A sterile speculum is used to look for fluid in the posterior vaginal fornix (pool test), which determines if ROM has occurred.

Fluid may be collected on a swab for further study if the source of fluid is unclear:

■ Ferning test (high estrogen content of amniotic fluid causes fern pattern on slide when allowed to air dry):

■ Crystallization/arborization is due to interaction of amniotic fluid proteins and salts.

■ Nitrazine test—nitrazine paper is pH sensitive and turns blue in presence of amniotic fluid:

■ Amniotic fluid (pH = 7.15) is more alkaline than vaginal secretions.

Fluid should also be examined for vernix or meconium.

■ The presence of meconium in the amniotic fluid may indicate fetal stress.

■ Meconium staining is more common in term and postterm pregnancies than in preterm pregnancies.

■ Meconium aspiration syndrome (MAS) can occur ^ infant tachypnea, costal retractions, cyanosis, coarse breath sounds, etc.

■ Prevent MAS via amnioinfusion intrapartum and DeLee suction post-partum

CERVICAL EXAM

Know this cervical exam stuff cold for the wards!!

There are four parameters of the cervix that are examined: effacement, consistency, dilation, and position.

Effacement

Effacement describes the length of the cervix. With labor, the cervix thins out and softens, and the length is reduced. The normal length is 3 to 4 cm. ■ Terminology: When the cervical length shrinks by 50% (to around 2 cm), it is said to be 50% effaced. When the cervix becomes as thin as the adjacent as the lower uterine segment it is 100% effaced.

Determination of effacement: Palpate with finger and estimate the length from the internal to external os.

Dilation

Dilation describes the size of the opening of the cervix at the external os.

■ Ranges: Ranges from closed or zero to fully dilated (10 cm). The presenting part of a term-sized infant can usually pass through a cervix that is fully dilated.

■ Determination of dilation: The examining finger is swept from the margin of the cervix on one side to the opposite side.

Cervical Position

Position describes the location of cervix with respect to the fetal presenting part. It is classified as one of the following:

■ Posterior—difficult to palpate because it is behind the fetus, and usually high in the pelvis

■ Midposition

■ Anterior—easy to palpate, low down in pelvis

During labor, the cervical position usually progresses from posterior to anterior.

Cervical Consistency

Consistency ranges from firm to soft. Soft indicates onset of labor.

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