the gynaecological examination angela laughton clinical education manager/midwife bradford teaching...
TRANSCRIPT
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The Gynaecological Examination
Angela Laughton
Clinical Education Manager/Midwife
Bradford Teaching Hospitals NHS Trust
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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
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Abdominal examination
Patient preparation!InspectionPalpationPercussionAuscultation (if appropriate)
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Pelvic Examination
Patient informed consent and chaperoneInspection of external genitaliaAsk patient to strain and/or coughSpeculum examinationBimanual examination
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Speculum Examination & Smear testing
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Aims
To understand:Indications for speculum examinationThe process of bivalve & univalve
speculum examinationCommon findingsIndications for cervical smearThe process of taking a cervical smear
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So why do we do it??
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Speculum Examination Indications
Routine screeningProlapsePostcoital bleeding, intermittent
menstrual bleedingPainful intercoursePresence of infection / discharge
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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.
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Equipment
GlovesSpeculumLubricating jellyExamination couch and a ‘modesty
sheet’Adequate lightingEnsure speculum is warmed and all
equipment is in working order
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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.
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Inspection
Hair distribution Vulval skin Look at the perineum
for scars/tears Gently part labia –
inspect urethra Look for discharge,
prolapse, ulcers, warts
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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
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Visualisation of Cervix
Inspect for:• Discharge• Warts• Tumours• Size of cervical os• Bleeding
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Univalve Speculum Positioning
Position patient in the left lateral position
Knees drawn up to chest
Hold back anterior vaginal wall with lubricated speculum
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Findings
Ask the patient to cough: Rectocele CystoceleLiquor
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Taking a Cervical Smear
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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
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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
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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.
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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.
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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
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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
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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