Healthcare and Medicine Reference
In-Depth Information
10
Remove the examining fi ngers gently and inspect glove for
Anteversion
blood/discharge.
Replace the drape over the woman's legs, providing tissues and
11
privacy for the patient.
Potential complications
As for speculum examination.
Front
Back
90
°
Retroversion
Specifi c requirements
None
Handy hints/troubleshooting
Long axis of vagina
Long axis of
cervical canal
Start with the non-dominant hand high on the patient's abdomen
to avoid missing substantial masses.
An empty bladder makes palpation of the uterus easier.
An acutely retroverted/retrofl exed cervix/uterus may be
diffi cult to palpate as may the uterus/ovaries in overweight or
postmenopausal women.
If the patient cannot relax the abdominal muscles to allow
Retroflexion
bimanual palpation, examination may be more successful carried
out in the left lateral position.
Long axis of
uterus
Anteversion
170
°
Acknowledgements
We would like to thank Justin Clark for his help and guidance.
Long axis
of cervical canal
Figure 23.5 The positions of the uterus and cervix.
Further reading
National Institute for Health and Clinical Excellence. (2003) Liquid-based
cytology for cervical screening. NICE technology appraisal guidance 69 .
www.nice.org.uk/nicemedia/pdf/TA69_LBC_review_FullGuidance.pdf
NHS Cervical Screening Programme. www.cancerscreening.nhs.uk/cervical/
index.html
Royal College of General Practitioners: RCGP Sex, Drugs and HIV Task
Group. Sexually Transmitted Infections in Primary Care. www.bashh.org/
primarycare/stis_primary_care_march2006.pdf
Royal College of Obstetricians and Gynaecologists. Clinical Governance
Advice No. 6 (October 2004) Obtaining Valid Consent www.rcog.org.uk/
resources/Public/pdf/CGA_No6.pdf
Royal College of Obstetricians and Gynaecologists. Gynaecological
Examinations: Guidelines for Specialist Practice (July 2002) www.rcog.org.
uk/resources/public/pdf/WP_GynaeExams4.pdf)
Note whether the cervix is ante- or retroverted (angulated for-
z
ward or backwards in relation to the vagina), and the uterus
ante- or retrofl exed (position in relation to the cervix).
See Figure 23.5 for the positions of the uterus and cervix.
Pouch of Douglas.
8
Continue gentle suprapubic pressure and move your fi ngers
z
behind the cervix and feel for any nodules i.e. on the uterosacral
ligaments from endometriosis.
Adnexae.
9
Then move the non-dominant hand abdominally to approxi-
z
mately 4 cm medial from the iliac crest and your examining fi n-
gers vaginally into the right fornix to examine the right andexae.
Gently sweep the abdominal hand downwards to palpate the
adnexae between the two hands and assess size and tenderness.
In the absence of any pathology the fallopian tubes and ovaries
are often not palpable.
Repeat on the opposite side, this time with the vaginal fi ngers
z
in the left fornix.
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