The Gynecologic Examination

Front 1

For many women, their yearly __________ is the only time they see their physician.

Back 1

pap smear

Front 2

What other types of examinations should take part at the same time of the gynecologic examination?

What should the doctor pay particular attention to?

Back 2

complete history and physical examination

the history should be thorough as covered in the initial history lecture

particular attention should be paid to potential risk factors for infection, cancers, and potential domestic abuse

sexual history should be taken( take history when patient is dressed)

concerns about physical examinations should be elicited

Front 3

What should the history and physical examination be directed by?

Back 3

the patient's age

Front 4

What should the doctor educate an adolescent patient about?

Back 4

take every opportunity to educate adolescent patients about the importance of sexually transmitted disease and pregnancy prevention

give teens info. regarding ways of screening for disease that are available, and the rationale behind their use, as well as being sensitive to their concern

imp. to discuss not only long term health benefits of screening (i.e. preventing cervical cancer) but also shorter term benefits of prevention (preventing genital warts, herpes and infertility)

Front 5

What should the doctor educate a woman of childbearing age about?

Back 5

ways to ensure healthy pregnancies, such as folate intake, and avoidance of alcohol and tobacco during pregnancy

STD prevention and cancer screening

Front 6

What should the doctor educate older women about?

Back 6

often they are still sexually active, and at risk for HIV and other sexually transmitted infections.

Address cancer prevention and menopausal symptoms

Front 7

Your patient's anxiety level will vary based on their age and past experience. What should the doctor do to alleviate anxiety?

Back 7

explain what will take place, show the equipment that will be used

Front 8

What should a doctor do to make sure the patient is as comfortable as possible?

Back 8

-take the history with the patient dressed
-keep the patient as draped as possible
-maintain eye contact so that discomfort can be detected
-ALWAYS have a chaperone present during breast and pelvic exam
-Allow patient to dress before returning to discuss findings
-be aware of and sensitive to cultural differences

Front 9

What should the doctor ask the pt to determine the details of their menstrual cycle?

Back 9

-Age of menarche- avg. age is U.S> is 11; normal range is from 9-17yrs.
-Date of last menstrual period (LMP)- the first day of the last menstrual period
-Date of the last normal menstrual period (LNMP)
-Duration of menses- usually 3-7 days
-Interval and regularity of menstrual cycles- avg. interval from first day of one menses to first day of next menses is 24-32 days)
-Character and amount of menstrual flow (# of pads or tampons/day)

Front 10

The doctor should ask the pt about what 4 abnormalities of the menstrual cycle?

Back 10

1. menorrhagia- excessive bleeding
2. metrorrhagia or intermenstrual bleeding- bleeding irregularly in between periods
3. dysmenorrhea-painful menstration, usually cramping or bloating
4. premenstrual symptoms (PMS) occurs 4-10 days before onset of menses

Front 11

What is menorrhagia?

Back 11

excessive menstrual bleeding, either amount or duration

Front 12

What is metrorrhagia?

Back 12

aka: intermenstrual bleeding- bleeding occurring irregularly in between periods

Front 13

What is dysmenorrhea?

Back 13

painful menstruation, usually cramping or aching

Front 14

What are some of the premenstrual symptoms (PMS) a pt. may experience 4-10 days before the onset of menses?

Back 14

tension, nervousness, irritability, depression, mood swings, weight gain, edema, breast tenderness and headaches

symptoms improve with onset of menses

Front 15

What 7 items should be discussed when taking a pts. sexual history?

Back 15

1. current sexual activity- be nonjudgmental, matter of fact and be aware of sexual biases that may interfere with patient care

2. number of prior partners and partner history of IV drug use and bisexual relationship

3. sexual gender preference- male, female, or both

4. method of contraception- length of use, complications, side effects and satisfaction with method

5. use of condoms and consistency of use

6. history of sexually transmitted diseases. ask pts if they have had any pelvic infections, or infections spread by sexual activity. (gonorrhea, herpes simplex types 1 and 2, chlamydia, syphilis, hepatitis types B and C and HIV

7. satisfaction with her sexual relationship- both her relationship with her partner and any problems with intercourse

Front 16

What are the two parts of the menstrual history that should be taken?

Back 16

details of menstrual cycle

ask about any abnormalities of the menstrual cycle

Front 17

What are the 4 things that a doctor should find out while taking the pts gynecologic history?

Back 17

1. frequency of prior Pap smears
2. history of prior abnormal Pap smears
3. Gynecologic procedures, such as IUD placement, hysterectomy, ovarian surgeries (**ask why hysterectomy or ovarian surgery was done)
4. Risk factors for cervical, ovarian, and endometrial cancer

Front 18

What should the frequency of pap smears be?

Back 18

previously recommended to be done annually

current recommendations are for every 3 years screening using cytology alone

women over 30 who are screened with cytology plus HPV testing can be done every 5 years

Front 19

What is the 2nd most common cancer in women worldwide?

Back 19

cervical cancer

Front 20

What are 6 risk factors for cervical cancer?

Back 20

(side note: Yuck to picture!)

1. age of patient (in U.S it peaks at 45-49 years)
2. early age of first intercourse increases cervical cancer risk, thought to be due to the exposure of susceptible cells to carcinogens
3. history of cervical dysplasia-disordered growth of abnormal zones
4. history of infection with human papillomavirus
5. HIV positive
6. Smoking increases risk up to four fold

Front 21

What is cervical dysplasia?

Back 21

disordered growth of abnormal zones

Front 22

What are 7 ovarian risk factors?

Back 22

1. age of patient- risk increase with age; highest proportion of patients are diagnoses between 50-59
2. early menarche- defined as prior to 12 years of age
3. late menopause- after age 55
4. infertility or nulliparity- thought to related to increased ovulation over a women's lifetime
5. history of fertility drug use- this is difficult to determine, current studies have methodologic issues. A potential confounding factor is that infertile women are more likely to use fertility drugs
6. family or personal history- breast cancer patients are twice as likely to get ovarian cancer
7. prolonged use of oral contraceptives decreases a women's risk of ovarian cancer

Front 23

Which cancer is insidious and difficult to diagnose in its early stages?

Back 23

ovarian cancer

Front 24

What is the most common gynecologic malignancy in American women?

Back 24

endometrial (uterine) cancer

Front 25

What are the risk factors of endometrial (uterine) cancer?

Back 25

1. Poptmenopausal- the mean age for diagnosis is in the early 60's. Has been reported in women as young as 30, becomes much more likely in older women
2. early menarche and late menopause increases risk due to prolonged endogenous exposure to estrogen
3. women with nulliparity, or chronic anovulation (presenting with irregular, infrequent periods) have increased risk due to endometrial hyperplasia, lack of progesterone effect. The risk associated with nulliparity is probably related to the anovulatory cycles found in many nulliparous women
4. obesity leads to increased exposure to estrogen due to the conversion of androstenedione to estrone which occurs in the peripheral adipose tissue
5. history

Front 26

When can endometrial cancer be detected?

Back 26

at an early stage, when it responds well to treatment

Front 27

What is the most common type (80%) of endometrial cancer related to?

Back 27

excess exposure to either exogenous or endogenous estrogens

Front 28

What 5 things should be asked when taking a obstetric history?

Back 28

1. gravida: the total number of pregnancies, regardless of outcome
2. para: the number of pregnancies carried past 20 weeks (viable)
3. aborta: the number of fetal losses, both spontaneous and induced
4.living: the number of living children
5. ask regarding complications of prior pregnancies

Front 29

Define gravida.

Back 29

the total number of pregnancies, regardless of outcome

Front 30

Define para.

Back 30

the number of pregnancies carried past 20 week (viable)

Front 31

Define aborta.

Back 31

The number of fetal losses, both spontaneous and induced :-(

Front 32

When taking a obstetric history, what 4 things should be asked regarding complications from prior pregnancies?

Back 32

1.preterm labor-how early, and why?
2.bleeding, including timing of pregnancy, any transfusions needed?
3. tubal pregnancies-these are often associated with scarring from previous infections
4. diabetes or hypertension with pregnancy- increase the risk a woman will later develop these chronic conditions

Front 33

What 5 things should be discussed when taking a menopausal history?

Back 33

1. age at menopause (avg. 51)
2. age of mother at menopause
3. associated symptoms- mood shifts, vasomotor changes, vaginal dryness
4. menopausal bleeding is considered abnormal after one year of absent menses. This can be a sign of endometrial cancer.
5. Medications or alternative therapies utilized and response/ side effects

Front 34

Define menopause.

Back 34

the absence of menses for one year

Front 35

what is the average age of menopause in the U.S.?

Back 35

51

Front 36

What are 3 associated symptoms of menopause?

Back 36

mood shifts, vasomotor changes, vaginal dryness

Front 37

A women is 51 years old. She has been in menopause for two years now. She just experienced menopausal bleeding. What could this be a sign of?

Back 37

endometrial cancer

Front 38

What are the 2 vestibular glands.

Back 38

1. Skene's gland- periurethral
2. Bartholin's glands- usually not visible, their opening is located between the labia minora and the hymen. Their function is to secrete mucous for lubrication

Front 39

What is the fourchette?

Back 39

posterior fusion of labia minora

Front 40

What equipment does the doctor need to make sure is available prior to giving a gynecologic examination?

Back 40

a. gowned with a drape over the patient's legs
b. speculum- metal or plastic, come in two different shapes, different sizes
c. brush, spatula, slide, and fixative for Pap smear
d. gloves are essential, including additional gloves for changing for the rectal examination
e. lubricant to be used for bimanual exam
f. light source- can be external or come attached to the speculum
g. culture material if indicated. cultures are often indicated in sexually active adolescents, pregnant women, women with symptoms of discharge or pain, or women at higher risk for STD's

Front 41

What are the ten steps IN ORDER that the doctor must follow when giving the pelvic examination? (these take place before the actual examination itself)

Back 41

1. ask the pt to empty her bladder before beginning the exam
2. ask the pts permission to proceed with the exam
3. a chaperone should always be present
4. the pt is usually in the dorsal lithotomy position
5. have the pt move down until her buttocks are at the edg of the table
6. make the pt as comfortable as possible
7. raise the head of the bed to a position that will allow you to maintain eye contact
8. position th drape across the knees in a way that will allow you to see the pts face
9. ask the pt to let her legs fall open
10. tell the pt you will be starting the exam, and begin with a neutral touch (on her thigh)

Front 42

What 10 things should be inspected?

Back 42

1. hair distribution
2. labia majora
3. labia minora
4. clitoris
5. urethra
6. vaginal introitus
7. perineum
8. skene's glands
9. bartholin's glands
10. observe for prolapse

Front 43

What should the dr look for when inspecting hair distribution?

Back 43

look for Tanner staging
lice

Front 44

What should the dr look for when inspecting labia majora?

Back 44

swelling
excoriation
rashes
growths

Front 45

How should the dr examine the labia minora?

Back 45

separate the labia majora with the gloved fingers of one hand in order to inspect

palpate the labia minora between the thumb and second finger

Front 46

What should the dr look for when inspecting the clitoris?

Back 46

look for enlargement that may indicate excess masculine hormones

Front 47

How should the dr. examine the Skene's glands? (3 steps)

Back 47

1. place index finger with palm upwards into the vagina
2. exerting upward pressure, milk the Skene's glands by moving the finger outward
3. repeat on the opposite side

Front 48

How should the dr. examine the bartholin's glands?

Back 48

1. palpate the posterolateral portion of the labia majora
2. palpate individually on each side

Front 49

What is a Bartholin Cyst? What are some of the reasons a pt may have this?

Back 49

it is due to chronic inflammation

an acute bartholin abscess is usually due to gonorrhea or staphylococcus

Front 50

What should the dr ask the pt to do when observing for prolapse?

Back 50

to bear down

Front 51

What does a cystocele cause?

Back 51

a bulging of the anterior vaginal wall

Front 52

What does a rectocele cause?

Back 52

bulging of the posterior vaginal wall

Front 53

What does a uterine prolapse cause?

Back 53

cervical protrusion

Front 54

What are the three types of prolapse?

Back 54

1. cystocele
2. rectocele
3. uterine prolapse

Front 55

Describe the cervix. (length, color, etc.)

Back 55

1-3 cm long, pink, cartilaginous-like opening at the top of the vagina

Front 56

What is the area surrounding the cervix called?

Back 56

fornices (anterior, posterior, lateral)

Front 57

What does the adnexa include?

Back 57

fallopian tubes and ovaries

Front 58

List the steps to the speculum examination.

Back 58

-Be comfortable with opening and closing the speculum
-Chose the proper size
-Speculum should be lubricated-use water if doing Pap
-ask pt to continuously relax vaginal muscles
- place finger into vaginal introitus and apply gentle pressure down on the perineum
-insert speculum gently over your finger with inward and slightly downward movement
-avoid touching clitoris, or pinching skin and hair
-open speculum once fully inserted
-gently reposition if you cant find cervix right away (it is rarely necessary to locate cervix by palpation prior to speculum exam)
-once cervix is in view, lock speculum

Front 59

What color is the cervix normally? What color when preggers?

Back 59

pink

blue (indicated increased vascularity)

Front 60

What is the squamocolumnar junction?

Back 60

the junction of squamous epithelium and the columnar epithelium

Front 61

What should the position of the cervix be?

Back 61

midline

Front 62

What are Nabothian cysts? What do they look like? What do they result from?

Back 62

these appear as one or more translucent nodules on the cervical surface

they result from blocked secretions from the columnar epithelium, and are of no pathologic significance

Front 63

What four things should be noted when a dr sees any discharge.

Back 63

amount
color
consistency
odor

Front 64

What will the size and shape of cervical os be in a nulliparous woman?

Back 64

a small round or oval os

Front 65

What will the size and shape of the cervical os be in a parous woman?

Back 65

a slit-like os

trauma from childbirth may produce lacerations causing irregularities in the os

Front 66

What are traditionally used to obtain the specimens from the pap smear?

Back 66

cytobrush and spatula

Front 67

What are the steps of the Pap smear.

Back 67

- insert the long end of the spatula into the cervical os and rotate 360 degrees
- spread the specimen onto a glass slide
-insert the cytobrush into the cervical os and rotate one-half to one full turn
- roll the brush onto a glass slide and apply fixative

Front 68

What should be done for a thin-prep Pap smear?

Back 68

- use a plastic spatula to obtain a sample as in the traditional Pap smear
- rinse the spatula into the solution vial by swirling it 10 times
- insert the endocervical brush and rotate one-half to one turn
- rinse the brush in the solution 10 times

Front 69

How does the thin prep pap smear collect cells?

Back 69

in liquid form

Front 70

Why is the HPV testing Pap method not recommended for those under 30 yrs old?

Back 70

due to the high prevalence of HPV in this age group, with most infections resolving spontaneously

Front 71

What are the 3 available Pap methods? and what is their SENSITIVITY to detection of high grade squamous epithelial lesions?

Back 71

conventional Pap smear- 70%
Thin prep pap smear- 90%
HPV testing- 99%

Front 72

What are the 3 available Pap methods? and what is their SPECIFICITY to detection of high grade squamous epithelial lesions?

Back 72

conventional Pap smear- 95%
Thin prep pap smear- 93%
HPV testing- 86%

Front 73

What is the recommended frequency of screening?

Back 73

Different recommendation from different groups, inc. the American Cancer Society, the American College of Obstetricians and Gynecologists and the U.S. Preventative Services Taskforce.

Generally based on the natural history of cervical cancer, which is a latency period of 10 yrs
*every 3 yrs screening is currently recommended by most
*yearly Papsfor high risk groups
*can be discontinued at age 65-70 as long as pt has had three recent negative pap smears

Front 74

Human Papillomavirus- what % of infections resolve within 5 years?

Back 74

greater than 90%

Front 75

Human Papillomavirus is a major risk for what?

Back 75

invasive cervical cancer
specific types of HPV incur a much higher risk of cervical cancer (types 16 and 18)

vaccine is now available and recommended for all adolescent girls

Front 76

how is a gonococcal culture specimen collection taken?

Back 76

-insert a sterile cotton swab into the cervical os
-hold it for 10-30 secs
-spread the swab in a z-pattern over the culture media. MUST be kept refrigerated
- a specimen for culture may be obtained from the rectum as well
-the DNA probe is more commonly used than the culture

Front 77

During the gonococcal culture specimen collection, what is more commonly used instead of the culture?

Back 77

the DNA probe

Front 78

How is the DNA probe used?

Back 78

-it is a rapid and sensitive test for gonorrhea and chlamydia
-the DNA probe involves constructing a nucleic acid sequence (the probe) that will match to a sequence in the DNA and RNA of the target tissue
-Use a Dacron swab with a plastic or wire shaft
-Insert the swab into the cervical os and rotate it for 30 seconds
-Place the swab into a tube containing the specimen reagent
-Testing for gonorrhea and Chlamydia may also be done using nucleic acid amplification tests on urine specimens, thus avoiding the need for a pelvic examination

Front 79

What type of swab should be used during a DNA probe?

Back 79

Dacron swab with a plastic or wire shaft

Front 80

What is a Wet Mount used to detect? How is the test given?

Back 80

Used to detect Trichomonas vaginalis, bacterial vaginosis, and sometimes Candidiasis

obtain a swab of the vaginal discharge
smear the swab on a glass slide and add a drop of normal saline
place a coverslip on the slide and view under the microscope

Front 81

How is a KOH prep taken?

Back 81

collect specimen
smear specimen on the slide
add KOH to the specimen
place a cover slip and view under the microscope
the KOH dissolves epithelial cells and facilitates visualization of the mycelia of a fungus

Front 82

What does the KOH do in a KOH prep test?

Back 82

dissolves epithelial cells and facilitates visualization of the mycelia of a fungus

Front 83

In a NORMAL female answers the following:
Vaginal pH:
Describe Discharge:
Amine odor (KOH) whiff test:
Main Pt. Complaints:
What is present under the microscope:

Back 83

Front 84

In a female pt with BACTERIAL VAGINOSIS answers the following:
Vaginal pH:
Describe Discharge:
Amine odor (KOH) whiff test:
Main Pt. Complaints:
What is present under the microscope:

Back 84

Front 85

In a female pt with TRICHOMONAS VAGINOSIS answers the following:
Vaginal pH:
Describe Discharge:
Amine odor (KOH) whiff test:
Main Pt. Complaints:
What is present under the microscope:

Back 85

Front 86

In a female pt with CANDIDA VULVOVAGINITIS answers the following:
Vaginal pH:
Describe Discharge:
Amine odor (KOH) whiff test:
Main Pt. Complaints:
What is present under the microscope:

Back 86

Front 87

What should be observed during the speculum withdrawal? What should normal secretions look like? How about abnormal? How should the speculum be withdrawn?

Back 87

- note vaginal walls while withdrawing the speculum
- normal secretions are thin, clear or cloudy. Secretions are abnormal is frothy, curdy, gray, green, or yellow. They should not be malodorous.
- As you withdraw the speculum maintain downward pressure to avoid urethral trauma. Inspect the vagina walls as your withdraw the speculum.
-the speculum should be fully closed when the blades pass through the hymen

Front 88

How should the examiner position themselves during a bimanual exam?

Back 88

examiner should be standing

Front 89

What steps should the doctor take during the bimanual exam before locating the cervix?

Back 89

-this part of the exam is done with the examiner standing
-explain to the pt what will happen during the bimanual exam
-it is important to change your gloves
- lubricate the index and middle fingers of your examining hand
- insert the tips of the gloved index and middle fingers into the vaginal opening and press down, waiting for muscle relaxation
- palpate the vaginal walls as you insert your fingers
-palpate for cysts, nodules, masses, or growths

Front 90

During a bimanual exam what should be done when examining the cervix?

Back 90

- locate the cervix with the palmar surface of your fingers. palpate the cervix for size, length, and consistency. The consistency should be like the tip of your nose, unless pregnancy is present. During pregnancy the cervix has softer consistency
-note the position of the cervix, which will indicate the uterine position
-evaluate for cervical motion tenderness. move the cervix from side to side. 1-2 cm of movement should only cause minimal discomfort. Cervical motion tenderness can indicate pelvic inflammatory disease, or a ruptured tubal pregnancy

Front 91

What can cervical motion tenderness indicate?

Back 91

pelvic inflammatory disease or a ruptured tubal pregnancy

Front 92

During a bimanual exam what should be done to examine the uterus?

Back 92

-place the palm of your non-dominate hand on the pts abdomen just above the symphysis pubis. Place your intravaginal fingers in the anterior fornix. Push down and forward with the flat surface of the fingers of your abdominal hand. Push inward and upward with the fingers of your intravaginal hand. If the uterus is anteverted or anteflexed you will feel the fundus between the fingers of your two hands.
-palpate the uterus for size, shape, and contour. It should be pear-shaped, and 5.5-8 cm long. The uterine walls should feel firm and smooth in a non-pregnant woman
-an enlarged uterus may indicate pregnancy or tumor
-evaluate the uterus for mobility and tenderness by gently moving it between your intravaginal and abdominal hands. The uterus should be mobile in the anterior posterior plane. A fixed uterus may indicate adhesions. A tender uterus may indicate infection or a ruptured tubal pregnancy

Front 93

What may an enlarged uterus indicate?

Back 93

pregnancy or a tumor

Front 94

During a bimanual exam what should be done to examine the uterus if you are unable to feel the uterus with the first maneuver

Back 94

-if you are unable to feel the uterus with the previous maneuver, place your intravaginal fingers behind the cervix (in the posterior fornix). Press firmly down with the abdominal hand while pressing up against the cervix with the intravaginal hand. A retroverted or retroflexed uterus should be felt with this maneuver.

Front 95

What may a fixed uterus indicate? A tender uterus?

Back 95

A fixed uterus may indicate adhesions. A tender uterus may indicate infection or a ruptured tubal pregnancy

Front 96

During a bimanual exam what should be done to examine the adnexa and ovaries?

Back 96

-Place your abdominal hand in the right lower quadrant. Place your intravaginal fingers in the right lateral fornix with fingers facing upwards. Press the intravaginal fingers in and up towards the abdominal hand. At the same time, sweep the fingers of your abdomen hand deeply inward and downward toward the symphysis pubis
-repeat the maneuver on the left side
-normal ovaries feel firm, smooth and ovoid having a size of 3 cm by 2 cm by 1 cm. It is normal for ovaries to be moderately tender on palpation. Ovaries are difficult to feel in many women. Fallopian tubes should not be palpable.
-Postmenopausal ovaries and ovaries in obese women are usually not palpable.

Front 97

A rectovaginal exam allow the dr to reach ___cm higher into the pelvis.

Back 97

2.5 cm

Front 98

How should a rectovaginal exam be given?

Back 98

Change gloves and lubricate fingers since you may need to do a guaiac test that could be positive from vaginal bleeding
-ask the pt to consciously relax her rectal sphincter and explain that she may feel like she is having a bowel movement
-place your index finger in the vagina and your middle finger into her rectum, observing sphincter tone
-slide your rectal and vaginal fingers in as far as possible. Rotate the rectal finger to explore the anterior rectal wall. Palpate the rectovaginal septum
-this technique may be the only way to palpate a retroflexed uterus

Front 99

What technique may be the only way to palpate a retroflexed uterus

Back 99

rectovaginal exam

Front 100

What should the dr do at the completion of the physical examination?

Back 100

assist your pt to a sitting position
provide tissues and a sanitary pad
discuss with the pt the results of your examination

Front 101

Most organization recommend routine screening of U.S. women at age___?

Back 101

21

Front 102

When are pelvic exam indicated in teenagers?

Back 102

in certain situations 3 yrs after the start of sexual activity, or for any symptoms of lower abdominal pain or vaginal discharge or discomfort

Front 103

What precautions should be made when examining an older pt?
What are the differences in an older pt?
-labia major?
-vaginal tissues?
-urethra?
-vagina?
-rugae?
-cervix?
-ovaries?
-uterus?
What should the dr evaluate for?

Back 103

-consider the pts comfort
-the labia majora are flatter and smaller. The vaginal tissues are often atrophic and drier. The urethra may be located more posteriorly. The vagina is narrower and shorter. Rugae are absent. The cervix is usually smaller and paler. The overies are rarely palpable due to atrophy. The uterus is often small.
-evaluate for possible prolapse
-ask about urinary incontinence

Front 104

Can pelvic examinations be safely done in pregnancy?

Back 104

yes

Front 105

What should a good prenatal examination include? why?

Back 105

a complete history and physical exam, as other medical problems are often worsen or change during pregnancy. In addition medications and medical problems may affect the developing fetus.
-if a woman has not had a Pap smear, it should be done
-late in pregnancy, care must be take not to introduce infection

Front 106

What happens in early pregnancy (color wise)?

Back 106

the cervix, vagina, and vulva acquire a bluish color
the cervix softens
increased vaginal secretions occur
early uterine enlargement may be asymmetric

Front 107

As a general rule:
At 12 weeks gestation the uterus is at the ______?
At 20 weeks gestation the uterus is at the______?

Back 107

pelvic brim

umbilicus

Front 108

When does cervical dilatation? How is it measured and what is the range?

Back 108

usually occurs just prior to delivery

measured in centimeters, and ranges from 0 (closed) to 10 cm (complete dilatation)

Front 109

What does effacement refer to?

Back 109

thinning of the cervix that occurs when uterine contractions pull the cervix upward

Front 110

What does station refer to?

What does a positive cm recording tell you?
What does a negative cm recording tell you?

Back 110

-the position/location of the fetus in relation to the mother's ischial spines.
-it is recorded in centimeters
- A positive cm recording tells you the baby's presenting part is below the ischial spines
-A negative cm tells you that the baby's presenting part is above the ischial spines. Thus, a +2 station is much closer to delivery than a -2 station.

Front 111

Which station is closer to delivery: +2 or -2?

Back 111

+2 station