Internal (vaginal) research

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Along with the methods of external studies in obstetrics use the method of the study of vaginal. To limit the study of pregnant woman only outer techniques should not, because they cannot replace vaginal methods of research. Some midwives try to avoid vaginal studies, limiting its range of narrow readings from fear to infect a pregnant woman. Supporters of this old look exaggerate the danger vaginal studies.
The study of a large clinical material shows that at observance of all requirements of asepsis and antisepsis vaginal examination does not lead to infection of pregnant women. To limit the indications for vaginal research parturient women and the use solely of external methods bring much more harm to the interests of the mother and fetus than wide application vaginal studies.
To perform deliveries under the control of the vaginal research allows the doctor to timely prevent possible complications, to avoid serious mistakes.
So, all the women upon admission to the maternity facility and then after rupture of membranes (if necessary) must be vaginal examination. An experienced doctor can be limited to a single vaginal study done after rupture of membranes.
To pryamokishechnye research we react negatively as diagnostic value of it in comparison with the method of the study of vaginal low and the risk of contamination generic ways is extremely high.
To your vaginal study should be started only after antiseptic preparation woman. To this end, the midwife produces washing of external genitals boiled water with the use of disinfectants (solution of ammonia, Lysol, chloramines, monolepta and others).
Simultaneously exploring the doctor performs the processing of hands by way of Spasokukotskogo - Kochergina, after which he rubs cotton ball dipped in dezinficiruyusch solution, from front to back, first outside, then the internal surface of the external genital parts. Sterilized soft rubber catheter urine is produced. Upon completion of preparation woman doctor again washes his hands in the solution of ammonia, wiping them with alcohol and only after that starts vaginal study women.
With the aim of preventing the introduction of bacteria with external genital parts in the birth canal and reduce pain in vaginal examination fingers exploring hands, as a rule, grease sterile liquid vaseline or vegetable oils.
In the study fingers enter after breeding in the side of the labia so that they do not touch the past. After research douching is not made.
During the study, first of all note the condition of the external genital parts and perineum, and then the condition of the vagina and its arches, there can be scarring, partition, warts, etc., and, finally, the status of the neck and throat, hereinafter - the properties of membranes, and then move to the determination of the nature of predlagay part and to clarify its position towards the pelvis. At the same time feel the inner surface of the bone pelvis and define the required sizes, mainly conjugata diagonalis.
In conclusion, if necessary, inspect using mirrors in the cervix.
From the side of the external genital organs note edema (if any), old breaks, varicose veins, etc. also find Out the height of the perineum (low, medium or high), its turgor of tissues (sluggish, elastic), and capacity of the vagina (broad or narrow).
The feeling of vaginal part of cervix allows to judge about the degree of preparedness of the generic ways: did the smoothing (shortening) and cervical opening the external OS. If the latter occurs, then note the degree of disclosure of the throat and the nature of its edges (thick and thin, rigid, or Vice versa, is easily supple, elastic; Fig. 22-27). In the case of pressing predlagay part (usually head) and the anterior lip of the throat swelling of the latter is often very pronounced; failure to recognize such complications threatening dangers for mothers (death and the rejection of the lips), and sometimes may even lead to rupture of the uterus. At the same time is determined (or excluded) presence of pathological changes in tissues of the cervix, such as cancer colli uteri (more often during the examination of the neck on the mirrors).