(a) A pelvic examination is performed to confirm the pregnancy and to
determine gestation. An examiner will look for signs of pregnancy--Chadwick's sign
(color of cervix), Goodell's sign (softening of tip of cervix), and Hegar's sign (softening of
the region between the body of the uterus and cervix). He will also evaluate the size of
the uterine and the fundal height.
(b) Estimate of pelvic size. The examiner evaluates the position of the
ischial spines and tuberosities. He evaluates diagonal conjugate to estimate pelvic
canal size and whether it will allow passage of the fetus at the time of birth.
NOTE: One vaginal birth is not proof of adequate pelvic space for all subsequent
deliveries.
(c) Palpation of pelvic contents is done to identify any abnormal
masses or tumors.
(d) Nursing responsibilities.
1 Assemble necessary equipment (speculum, lubricant, spatula
for cervical scraping, glass slide, culture tube with sterile cotton-tipped applicator, exam
gloves, and exam light).
2 Have the patient empty her bladder so she is more comfortable.
It is easier for the examiner to evaluate the size of the uterus on an empty bladder.
3 Have the patient to remove her clothing and to put on a patient
gown. Allow for patient privacy while changing.
4 Position the patient on the exam table in the lithotomy position
with a drape to cover her (see figure 6-3).
Figure 6-3. Patient in the lithotomy position, draped for pelvic exam.
5 Reassure and encourage the patient to relax during the exam.
The patient can relax by taking two to three breaths and letting them out slowly through
her mouth.
MD0921
6-10
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