What does internal inspection check? How is it conducted?

Many mothers who have given birth know that before giving birth, they will undergo an internal examination to check the condition of the cervix. Many pregnant mothers find this examination embarrassing. So what does the internal examination check? How is the internal examination performed? Let's learn more about it together~

What is internal inspection?

Internal examination is also called internal diagnosis.

Internal examination is one of the routine gynecological examination methods. A speculum can be used to perform relevant vaginal examinations, or internal examination and triple examination of the vagina, etc., without obvious pain.

How to check internal inspection

The examiner wears sterile gloves on one hand, dips the index and middle fingers in a little sterile soap solution, and inserts them into the vagina to feel the elasticity and patency of the vagina, as well as the presence of tenderness, deformity, swelling, posterior fornix nodules, and fullness.

Then move two fingers in the vagina to the lateral fornix, and move the hand in the lower abdomen to one side of the pelvic cavity. Check the parauterine tissue, ovaries, and fallopian tubes between the inner and outer hands. Normal fallopian tubes are difficult to palpate, and ovaries can sometimes be touched, and there is a sore and swollen feeling when pressed. Pay attention to whether the appendages are thickened, tender, or lumps. If there are lumps, further check the size, shape, softness, hardness, mobility, tenderness, and relationship with the uterus.

Maternal:

Vaginal examination steps: The parturient takes the lithotomy position or supine position, routinely disinfects the vulva, spreads a sterile towel, and catheterizes or empties the bladder. The doctor washes his hands, wears gloves, and wears sterile clothing as usual, and then performs the examination after disinfecting the parturient's vulva.

The examining doctor stands on the right side of the parturient or facing her, uses his left hand to separate the labia minora, and uses his right hand to insert the index and middle fingers into the vaginal opening and squeeze towards the anus. If necessary, he inserts the whole hand into the vagina. The left hand is required to touch and press the fundus of the uterus, while the right hand only moves the fingers to touch. The hand or wrist should not move, so that the parturient will not feel uncomfortable.

Internal examination can be done from the vagina or the anus. Anal examination can reduce the chance of infection, but it is not as accurate as vaginal examination. Vaginal examination is to insert the index and middle fingers to touch the cervix to see if the cervix is ​​soft, whether the cervical canal has disappeared (the cervical canal is the original tube-shaped cervix, but it will slowly soften and enlarge like a balloon after delivery to facilitate the baby to come out), whether the cervix is ​​open, and if it is open, use your fingers to estimate how many fingers can fit in the middle. You can also understand the fetal presenting part, see if the head is down, whether it has entered the pelvis, and the position of the ischial spines (the ischial spines are the mid-pelvic position, and the baby must come out through the ischial spines), see if the head is in front or behind, and whether help is needed to turn the head (that is, the position of the occipital bone). Generally, anal examination is mostly used during the progress of labor, and vaginal examination is more common before delivery.

The role of internal inspection

1. The size, hardness, mobility, itching, pain, swelling or contact bleeding of the cervix.

2. The engagement of the fetal head. If the fetal head is not engaged, the shape and size of the pelvis can be understood to estimate whether the fetal head can pass through the vagina and whether there are any problems with vaginal delivery. If the fetal head is engaged, the condition of the pelvis below the presenting part can be understood to estimate the mode of delivery.

3. Fetal head position. The fetal position, cervical dilation, and soft birth canal conditions that are difficult to determine through anal examination can be achieved through vaginal examination.

4. Find the cause of fetal asphyxia. Knowing whether the fetal head is obstructed, whether there is a follicular tumor, whether the umbilical cord is hidden prolapsed, and whether the amniotic fluid is contaminated will help to deal with fetal distress in time.

5. Find the cause of vaginal bleeding. Anal examination cannot replace vaginal examination for vaginal bleeding before and during delivery. Vaginal examination can confirm the diagnosis and formulate the correct treatment plan. However, it is important to open the intravenous channel before the examination, prepare for blood transfusion and surgery, and decisively decide the mode of delivery once the diagnosis is confirmed. In particular, vaginal examination or anal examination is prohibited before placenta previa is ruled out.

6. Examination is necessary before surgical delivery. Before deciding on surgical delivery, a detailed vaginal examination should be performed to understand the surgical indications and the difficulty of the operation and prevent the occurrence of complications.

The difference between internal examination and anal examination

Vaginal and anal examinations can help understand the exposure of the fetus, the condition of the cervix and the pelvis during delivery. Anal examination is more suitable for understanding the condition of the posterior pelvis, while vaginal examination is clearer for other aspects. Anal and vaginal examinations are basic skills for obstetricians. They are very necessary for predicting the maturity of the cervix, predicting the mode of delivery, the progress of labor and the balance of the fetal head before and after delivery.

Pregnant mother's internal examination experience

Ah, today's inspection was hit by the internal inspection.

It was exactly 32 weeks, and I went to the hospital excitedly for an ultrasound on the first day back to work after the National Day holiday. I thought about the internal examination today, and at first I thought the girls in the forum said that internal examination was not that painful, and I thought it would only be a one-time thing, so it probably wouldn't be uncomfortable. But I was hit hard in the afternoon.

The first blow: At the end of the B-ultrasound, the doctor had to insert the probe into the vagina for the last time, probably to see if the inner opening was closed. As soon as she inserted the probe, I started to tremble. The angry doctor started to say to me: Ah, are you still going to have a baby like this? Relax, relax, I haven’t adjusted yet. The doctor inserted it directly, and fortunately it came out quickly. I just took it as a poke.

The second wave of attack: Before the internal examination, I asked the doctor if it hurts, and the doctor told me that it would be uncomfortable anyway. The doctor was too modest, probably to prevent me from having any psychological barriers, so he said it would be uncomfortable, but it turned out to be more than uncomfortable. He first used the duckbill for a while, and then threw it away. I immediately asked the doctor if it was done? The doctor said no. Then he put on gloves, and this was finally the challenge. He put his hand into the vagina, and it hurt so much that I shrank my buttocks. As a result, the doctor said again, ah, this is not okay, you have to relax, don't resist, otherwise the more you resist, the more painful it will be. After finally getting this done, I thought it should be over, but the third wave came.

The third wave of attack: The doctor asked me to hold my knees with my hands. I was so dumbfounded (pregnancy makes you dumb for three years), and asked the doctor how to hold them. The doctor said very depressedly to hold them with my hands, open my legs to both sides, and open them as wide as possible! Then he reached in and touched them again. It hurt, and tears flowed into my heart. In such a comfortable autumn, I was sweating profusely after the operation.