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Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier
Vaginal examination may be carried out to assess progress in labour. Although it is not essential to examine the woman vaginally at frequent intervals, it may be useful to do so when progress is in doubt or another indication arises. Under no circumstances should a midwife make a vaginal examination if there is any frank bleeding, unless the placenta is positively known to be in the upper uterine segment. The features that are indicative of progress are:
Cervix fully dilated
Progressive dilatation is monitored as labour continues and charted on either the partograph or the cervicograph. The level or station of the presenting part is estimated in relation to the ischial spines; during normal labour the head descends progressively. Moulding or a large caput will give a false impression of the level of the fetal head. In vertex presentations, progress depends partly on increased flexion. Flexion is assessed by the position of the sutures and fontanelles:
Rotation is assessed by noting changes in the position of the fetus between one examination and the next. The sutures and fontanelles are palpated in order to determine position. Under no circumstances should a midwife make a vaginal examination if there is any frank bleeding, unless the placenta is positively known to be in the upper uterine segment.
On vaginal examination, the breech feels soft and irregular with no sutures palpable. The anus may be felt, and fresh meconium on the examining finger is usually diagnostic.
On vaginal examination, the presenting part is high. The anterior fontanelle may be felt on one side of the pelvis, and the orbital ridges, and possibly the root of the nose, at the other. A large caput succedaneum may mask these landmarks if the woman has been in labour for some hours.
On vaginal examination, the presenting part is high, soft and irregular. The orbital ridges, eyes, nose and mouth mat be felt. As labour progresses the face becomes oedematous, making it more difficult to distinguish from a breech presentation. Care must be taken not to injure or infect the eyes.
Left mentoanterior position: A. the mentim is felt to the left and anteriorly; B. Following increased extension of the head, the mouth may be felt; C. The face has rotated 1/8 circle: orbital ridges in transverse diameter of the pelvis
Findings on vaginal examination will depend on the degree of flexion of the head; locating the anterior fontanelle in the anterior part of the pelvis is diagnostic of occipitoposterior presentation.
Vaginal examination should not be performed without first excluding placenta praevia.
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