The Gynaecological Examination Angela Laughton Clinical Education Manager/Midwife Bradford Teaching...
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Transcript of The Gynaecological Examination Angela Laughton Clinical Education Manager/Midwife Bradford Teaching...
The Gynaecological Examination
Angela Laughton
Clinical Education Manager/Midwife
Bradford Teaching Hospitals NHS Trust
General Examination
Introduction and smile! General examination of hands and mucous
membranes Supra-clavicular lymph nodes should be felt Thyroid gland should be palpated ‘Chest & Breasts’ Proceed with abdominal and pelvic
examination
Abdominal examination
Patient preparation!InspectionPalpationPercussionAuscultation (if appropriate)
Pelvic Examination
Patient informed consent and chaperoneInspection of external genitaliaAsk patient to strain and/or coughSpeculum examinationBimanual examination
Speculum Examination & Smear testing
Aims
To understand:Indications for speculum examinationThe process of bivalve & univalve
speculum examinationCommon findingsIndications for cervical smearThe process of taking a cervical smear
So why do we do it??
Speculum Examination Indications
Routine screeningProlapsePostcoital bleeding, intermittent
menstrual bleedingPainful intercoursePresence of infection / discharge
Preparation
Explain details of the procedure and gain verbal consent
Ask the patient to empty her bladder & remove any sanitary protection.
Allocate a separate private area for the patient to undress.
Chaperone should always be present.
Equipment
GlovesSpeculumLubricating jellyExamination couch and a ‘modesty
sheet’Adequate lightingEnsure speculum is warmed and all
equipment is in working order
Positioning
Patient should be supine.Place heels together with knees bent &
allow legs to ‘fall’ apart.The light should be adjusted to allow a
good view of the vulva and perineum.
Inspection
Hair distribution Vulval skin Look at the perineum
for scars/tears Gently part labia –
inspect urethra Look for discharge,
prolapse, ulcers, warts
Insertion
• Hold speculum so blades are orientated in direction of vaginal opening
• Part the labia and slowly insert, rotating the speculum until its blades are horizontal
Visualisation of Cervix
Inspect for:• Discharge• Warts• Tumours• Size of cervical os• Bleeding
Univalve Speculum Positioning
Position patient in the left lateral position
Knees drawn up to chest
Hold back anterior vaginal wall with lubricated speculum
Findings
Ask the patient to cough: Rectocele CystoceleLiquor
Taking a Cervical Smear
When and why?
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- Ca Cx second most common malignancy
Taking a cervical smear
Following insertion of bivalve speculumEquipment:Aylesbury spatulaConfirm name, DOB, hosp number etcLabel frosted end of slide
•Explain that the procedure may be uncomfortable
Taking a Cervical smear
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.
Concluding Cervical Smear
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.
What do the results mean?
Normal- means you have very low chance of developing ca of the cx but not 100% guarantee)
Inadequate- no true result can be given as ‘inadequate’ sample. Repeat smear indicated
Abnormal- minor changes are quite common, repeat smear 3-12 months advised
Bimanual Examination
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
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