OBSTETRICAL EXAMINATIONS : OBSTETRICAL EXAMINATIONS It all started when… : It all started when… What are the types of Obstetrical Examination? : What are the types of Obstetrical Examination? Bimanual Examination : Bimanual Examination Slide 8: bimanual examination is derived from two words: bis and manos which means hand
It is an examination, usually vaginal, that requires the use of both of the examiner's hands.
Definition: Part of a full pelvic (or gyn) examination where the health care professional inserts two fingers into the vagina and uses the other hand on the abdomen to be able to feel the internal pelvic organs, mainly the uterus and ovaries. Ideally, this is followed with a rectovaginal exam, for more complete information about the organs in the area. Procedure for bi-manual examination : Procedure for bi-manual examination FOR PREGNANT WOMEN:
Now stand to perform a bimanual examination.
Lubricate the index and middle fingers of your examining hand
continue the internal examination; insert two fingers into the vagina
Palpate the vaginal wall posteriorly, laterally, and anteriorly, including urethra and bladder region. Note nodulatiiest and tenderness
Palpate the cervix as well. Should be nontender and mobileNote size shape consistency, etc.
Feel the fornix around the cervix
Press down towards the intrauterine hand as it raises the uterus upwards. Note size shape consistency, etc.
Identify any masses or tenderness . Slide 10: FOR NON-PREGNANT WOMEN:
you may feel an antiverted uterus above the symphysis, it is usually firm and mobile .
To palpate the ovary, put your hand in right lower quadrant and your intravaginal hand in the right lateral fornix.
Press abdominal hand in and down to move the ovary within reach of the intravaginal hand .
Palpate the right ovary or any adnexal mass within the two hands .
Note its size shape consistency tenderness .
Repeat bimanual examination on left sides .
Ovaries are active and somewhat tender in non pregnant women Slide 11: Bimanual pelvic exam of a female, using two fingers inside the vagina and one hand on the outside of the abdomen. Rectovaginal Examination : Rectovaginal Examination Slide 13: Part of the pelvic or gyn examination where the health care professional palpates (feels) the internal pelvic organs by inserting one gloved finger in the rectum and one in the vagina. This is the best way to detect certain abnormalities, including parts of the uterus, ovaries, and colon, and is part of a good screening for ovarian cancer. Slide 14: Rectovaginal Procedure Pelvic Examination : Pelvic Examination Slide 16: Examination of a female's external and internal pelvic organs to screen for cancer and other abnormalities. Ideally, the annual examination should consist of 1) an examination of the vulva and vagina 2) a speculum exam of the cervix with Pap test 3) a bimanual exam and 4) recto-vaginal exam to feel for abnormalities in the internal organs. Pelvic Ultrasound : Pelvic Ultrasound Slide 19: Pelvic ultrasound is a procedure in which high-frequency sound waves create images of the pelvic organs. The sound waves are projected into the pelvis, and measure how they reflect—or echo—back from the different tissues.
A pelvic ultrasound looks at:
The bladder, ovaries, uterus, cervix, and fallopian tubes of a woman.
Organs and structures that are solid and uniform, like the uterus, ovaries, or prostate gland, or are fluid-filled, like the bladder, show up clearly on a pelvic ultrasound. Bones or air-filled organs, like the intestines, do not show up well on an ultrasound and may keep other organs from being seen clearly. Slide 20: Pelvic ultrasound can be done three ways:
A small handheld device called a transducer is passed back and forth over the lower belly. A trans-abdominal ultrasound is commonly done in women to look for large uterine fibroids or other problems.
The transducer is shaped to fit into the rectum. A trans-rectal ultrasound is the most common test to look at the male pelvic organs, such as the prostate and seminal vesicles. Sometimes, a small sample of tissue (biopsy) may be taken with small tools inserted through the rectum during a trans-rectal ultrasound.
The transducer is shaped to fit into a woman's vagina. A woman may have both trans-abdominal and trans-vaginal ultrasounds to look at the whole pelvic area. A trans-vaginal ultrasound is done to look for problems with fertility. In rare cases, a hysterosonogram is done to look at the inside of the uterus by filling the uterus with fluid during a trans-vaginal ultrasound. Sometimes, a small sample of tissue (biopsy) may be taken with small tools inserted through the vagina during a trans-vaginal ultrasound. Why It Is Done? : Why It Is Done? Find out what is causing pelvic pain.
Look for the cause of vaginal bleeding.
Look for pelvic inflammatory disease(PID).
Find an intrauterine device (IUD).
Look at the size and shape of the uterus and the thickness of the uterine lining.
Look at the size and shape of the ovaries.
Check the condition and size of the ovaries during treatment for infertility.
Confirm a pregnancy and whether it is in the uterus. Pelvic ultrasound may be used early in pregnancy to check the age of the pregnancy or to find a tubal pregnancy (ectopic pregnancy) or multiple pregnancy.
Check the cervical length in a pregnant woman at risk for preterm labor.
Check a lump found during a pelvic examination.
Check uterine fibroids found during a pelvic examination. Pelvic ultrasound may also be done to check the growth of uterine fibroids.
Guide a procedure to remove an ovarian follicle for in-vitro fertilization. Preparation for Pelvic Ultrasound : Preparation for Pelvic Ultrasound Before undergoing a pelvic ultrasound, the patient may be asked to drink several glasses of water and to avoid urinating for about one hour prior to exam time. When the bladder is full, it forms a convenient path, called an acoustic window, for the ultrasonic waves. A full bladder is not necessary for an endo-vaginal examination, sometimes making it a preferred choice in emergency situations. Women usually empty their bladders completely before an endo-vaginal exam. View of the Pelvic Ultrasound : View of the Pelvic Ultrasound Pap Smear : Pap Smear Slide 25: The Pap test, named for its inventor, Dr. George Papanicolaou, is a test of cells collected from a woman's cervix. The cells are examined under a microscope to look for abnormalities, especially those that may be precancerous (dysplasia). These cells are taken with a small brush or wooden scraper and either placed ("smeared") on a slide or placed in a liquid fixative and then sent to a laboratory for examination. Pap Smear Procedure : Pap Smear Procedure To collect endo-cervical cells, insert a saline-moistened cottoned applicator into the cervical os. Rotate it 360 degrees, then swab onto a slide, and fix it.
To obtain a specimen from the ecto-cervix including squamocolumnar junction. place longer end of spatula into the end of the cervical os, rotate 360 degrees, and gently smear on glass slide and fix it as before .
Both of previous methods can be used in pregnant and non pregnant women.
To observe the vaginal walls, unlock it the speculum, and withdraw it slowly, keeping it open with your thumb while you observe the vaginal mucosa. Note any masses, discolorations, etc. gradually close it, and withdraw it from the vaginal canal. Slide 27: How it is done… THE " j" group : THE " j" group Super “J” : Super “J” ODETTE TINA CARLA GEAN MA’AM SHANDZ SUBMITTED TO: : SUBMITTED TO: Super NHINA SANDEEP DE ROSAS, RN : Super NHINA SANDEEP DE ROSAS, RN Resources : Resources Ilmu kedokeran