Internal Examination in Obstetrics

Internal examination primarily refers to gynecological examination. During pregnancy, it is crucial for pregnant women to regularly undergo prenatal check-ups at hospitals to understand their physical condition and the development of the fetus. Prenatal check-ups span the entire pregnancy period. Internal examination is one of the routine gynecological examination methods, which generally does not cause severe pain and is therefore tolerable. It is advisable to relax and avoid excessive tension during the examination.

Is Internal Examination Uncomfortable?

Internal examination may cause a certain degree of discomfort, but it does not lead to severe pain and is therefore tolerable. The cervix is composed of epithelial cells that do not transmit pain sensations, and any discomfort felt during the examination may be due to excessive tension. Therefore, it is recommended to prepare well before the examination to ease any discomfort.

During prenatal internal examination, it is essential to assess how much the cervix of the pregnant woman has dilated. When the cervix is fully dilated, it measures ten fingers. In most cases, a fully dilated cervix allows for a vaginal delivery, but there are exceptions.

The process of internal examination involves the pregnant woman lying down, removing her pants, and spreading her legs on leg rests. The doctor then inserts one finger into the vagina and places the other hand on the abdomen to examine the position, size, and other aspects of the cervix.

Role of Prenatal Internal Examination

1. Engagement of the fetal head: When the fetal head is not engaged, it allows for the assessment of the pelvic shape and size to estimate whether the fetal head can pass through the vagina and whether there are any issues with vaginal delivery. Once the fetal head is engaged, it provides information about the pelvic condition below the presenting part, helping to estimate the mode of delivery.

2. Position of the fetal head: Vaginal examination is used to determine the fetal position, expansion of the cervix, and condition of the soft birth canal, which may be difficult to assess through rectal examination.

3. Identifying causes of fetal distress: Understanding whether the fetal head is obstructed, the presence of birth tumors, hidden prolapse of the umbilical cord, and pollution of amniotic fluid helps in the timely management of fetal distress.

4. Investigating causes of vaginal bleeding: Vaginal examination is irreplaceable in cases of prenatal and intrapartum vaginal bleeding, as it allows for accurate diagnosis and formulation of appropriate treatment plans. However, it is crucial to establish intravenous access, prepare for blood transfusion and surgery before the examination, and make a decisive decision on the mode of delivery once a diagnosis is confirmed. Vaginal or rectal examination is contraindicated in cases of suspected placenta previa.

5. Preoperative assessment: Detailed vaginal examination is essential before deciding on surgical delivery to assess the surgical indications, difficulty level, and prevention of complications.