Gynaecological history, examination and investigations
Helen Bickerstaff, Louise C Kenny in Gynaecology, 2017
A sterile speculum is an instrument that is inserted into the vagina to obtain a clearer view of part of the vagina or pelvic organs. There are two principal types in widespread use. The first is a bivalve or Cusco’s speculum (Figure 2.3A), which holds back the anterior and posterior walls of the vagina and allows visualization of the cervix when opened out (Figure 2.3B). It has a retaining screw that can be tightened to allow the speculum to stay in place while a procedure or sample is taken from the cervix (e.g. smear or swab). A Sim’s speculum (Figure 2.4A) may also be used for examination of prolapse as it allows inspection of the vaginal walls. It is used in the left lateral position (Figure 2.4B). The choice of speculum will depend on the patient’s presenting problem.
Interventional Ultrasound in Diagnosis and Treatment of Female Infertility
Asim Kurjak in Ultrasound and Infertility, 2020
The reported technique is more or less the same and includes examination of patients with full urinary bladders with commercially available real-time ultrasonic equipment. After inserting a vaginal speculum, the vagina and cervix are cleaned with antiseptic solution. A suitable cannula is then inserted inside the cervical canal and the speculum is removed. The ultrasonic probe is placed over the lower abdomen and a baseline transverse scan at the level of the middle uterine part is performed. Isotonic sterile saline solution is then injected into the uterus by means of plastic syringes or pressure pump with pressure not exceeding 80 mm of mercury. It is important to fill the cannula with fluid before instillation to avoid air bubbles. A diagnostic sign of at least one tube patency is the appearance of free fluid in the pouch of Douglas.
The intrauterine system (IUS)
Suzanne Everett in Handbook of Contraception and Sexual Health, 2020
Insertion of an IUS is performed by a ‘non-touch technique’, so a clean pair of gloves should be used following bimanual examination. A sterile speculum is inserted into the vagina and the cervix is located; this is then cleaned with sterile cotton wool and antiseptic solution. A uterine sound is inserted into the uterus via the cervical canal to measure the length, direction and patency of the uterus. This may cause cramp-like period pains, which should diminish when the uterine sound is removed. The cervix may be stabilised by Allis forceps or a tenaculum so that the IUS may be inserted more easily; these may cause some discomfort as the cervix is very sensitive. As the introducer to the IUS is wider than other IUDs, Hegar dilators may need to be used to dilate the cervix to Hegar 5 or 6 in diameter. This may be uncomfortable and local anaesthetic can help to alleviate this discomfort. Next the IUS is inserted through the cervical canal into the uterus. The threads of the IUS are shortened once it is in position and are tucked up behind the cervix. Fundal positioning of the IUS is extremely important to reduce the risk of expulsion and to ensure the endometrium has full exposure to the progestogen in the device and maximum efficacy is obtained.
Clinical management of vaginal bleeding in postmenopausal women
Published in Climacteric, 2020
The initial physical examination should include a detailed evaluation of the external and internal genitalia, aiming to determine the bleeding site and looking for suspicious lesions, skin lacerations, or the presence of foreign bodies. A detailed inspection of the vulva, the urethra, and the anus is also recommended. A vaginal speculum examination should be performed, inspecting the vaginal mucosa and looking for atrophic vaginitis or suspicious vaginal lesions. Cervical cytology, if indicated, should be collected as part of the evaluation. Any cervical visible macroscopic lesion suspicious for cancer must be biopsied. A bimanual examination should then be performed to evaluate uterine size, mobility, the presence of adnexal pathology, and cervical motion tenderness. It may be appropriate to collect a vaginal swab if the presence of a sexually transmitted infection is suspected. To conclude, a general physical examination should be performed to look for signs of systemic illness.
Quantitative cervicovaginal fetal fibronectin as a predictor of cervical ripening and induced labour duration in late-term pregnancy
Published in Journal of Obstetrics and Gynaecology, 2023
Modupe Olatokunbo Adedeji, Ayokunle Moses Olumodeji, Adetokunbo Olusegun Fabamwo, Oyedokun Yekini Oyedele
A digital vaginal examination for the cervical assessment using the modified Bishop score was done immediately after obtaining the swab sample for foetal fibronectin. Only patients with a score of 6 or less, as stated in the inclusion criteria, were eligible to continue in the study. The patients were placed in a lithotomy position and the vagina was cleaned with an aseptic solution (chlorhexidine). A sterile Cusco speculum was inserted in the vagina to visualise the cervix. A size 22 Foley’s catheter was gripped with the sponge forceps and advanced up the endocervical canal through to the internal cervical os under aseptic conditions. The balloon of the catheter was inflated with 30 ml of sterile water. Thereafter, gentle traction was applied to the catheter and strapped down to the inner aspect of the woman’s thigh with adhesive tape. After the 24-hour period, the catheter is expected to have fallen out spontaneously or be removed with gentle traction. Hence, the cervix was reassessed with the Modified Bishop Scoring system (Wormer et al.2022). Induction of labour was commenced when the modified Bishop score was > 6. On the other hand, women who remained with an unfavourable cervix after 24 hours had a new catheter replaced for another 24-hour period. Women who had unfavourable cervix despite 48-hours attempts at cervical ripening exited the study to allow for alternative means of cervical ripening according to the study hospital labour ward protocol.
Clinical analysis of high-intensity focused ultrasound (HIFU) combined with hysteroscopy-guided suction curettage (HGSC) in patients with cervical pregnancy
Published in International Journal of Hyperthermia, 2022
Yufu Huang, Xiaogang Zhu, Luying Wang, Mingzhu Ye, Min Xue, Xinliang Deng, Xin Sun
2 ± 1 days (range: 1–3 days) after HIFU treatment, the patients underwent the suction curettage under the HEOS hysteroscopic guidance (Sopro-comeg Company, Bordeaux, France). After 8 h of fasting, the patient was placed in the lithotomy position and was given intravenous general anesthesia. Then routine disinfection and draping were performed. After inserting the speculum into the vagina, the patient’s cervix was held in place with a clamp. A 0.9% saline (speed: 400 ml/min) was sent through the catheter into the uterus to cause dilation. To determine the depth and angle of the uterus and localize the gestational sac, a rigid hysteroscope with a diameter of 4.5 mm (Olympus) was inserted into the uterus. The cervix was widened by gradually increasing the size of the dilator to 7.5 mm. The 7 mm cavity suction tube was used to scrape and suction the placental contents in the cervix. Hysteroscope was used to check if any contents remained in the uterus. If any pregnancy residues were detected, a clamp was used under the guidance of a hysteroscope with an outer sheath (diameter: 6.5 mm) to remove the remaining tissue. If necessary, an electrosurgical resection was used to remove the residues after re-dilation of the uterus.
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