Clinical Protocols and Guidelines CP–MA118

Maternity (all sites) l Vaginal speculum examination in pregnancy - Protocol

Vaginal speculum examination in pregnancy - Protocol

To be read in conjunction with other relevant maternity clinical practice guidelines as referenced.

Definition

Passing a vaginal speculum for the above procedures.

Expected outcomes

Confirmation of diagnosis of spontaneous rupture of membranes.

Collection of vaginal swabs.

Precautions

The examination is possibly one of the most intimate and hence potentially distressing and
embarrassing that woman undergo and therefore it must be approached with care and
sensitivity.

Caution
Speculum examination should only be undertaken by clinicians who have successfully
1
attained Southern Health competency in ‘vaginal speculum examination’.
Equipment

- a range of speculae (long, narrow, large etc)

- disposable under sheet

- tissues or gauze

- spotlight

- sterile gloves

- equipment required for general microscopy and culture /or pap smear.

Offer a chaperone for the examination, friend / partner or another clinician: irrespective
of gender of the midwife or doctor.2

Step 1

Introduce yourself to the woman and explain the purpose of the examination. Take a full
history.

Step 2

Ensure privacy (a drawn curtain in a busy ward or clinic is not adequate) and that the
room is warm.

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Maternity (all sites) l Vaginal speculum examination in pregnancy - Protocol

Step 3

Ask the woman to remove her underwear and provide a sheet so that she can cover herself
up. Ensure privacy while she undresses and then return promptly to carry out the
examination.

Step 4

Positioning: Ask the woman to lie on her back, draw her feet up towards her bottom and
let her knees fall apart. Place pillow under her head and under her hip.

If the woman prefers the procedure may also be undertaken at the in the left lateral.

In some situations it may be easier to visualise the cervix in the left lateral position.

Step 5

Inspect the vulva looking for rashes, atrophy, ulcers, lumps and discharge.

Step 6

This is a sterile examination, warmed sterile water may be used to lubricate and warm the
speculum.

Using a sterile cloth, position the spot lamp so that it shines onto the vulva.

Step 7

Part the labia gently with gloved fingers and insert the speculum closed with the blades in
the horizontal plane or slightly to the oblique.

Pass the speculum its full length or until resistance is felt and then rotate the speculum (if
in the oblique position), move your thumb to the thumb piece and press to open blades so
that the cervix is in view.

Sweep blades upwards and gently press on the handle. When cervix is in view, tighten the
thumbscrew to keep blades open. Observe for fluid leaking from the cervix, it may be
helpful to ask the woman to cough. Inspect the vagina for evidence of discharge or a
“washed out appearance.

Step 8

Inspect the cervix and take swabs, smears, cervical brush smears etc as indicated.2,3,4,5

Step 9

Close the speculum gradually as you withdraw it (to avoid trapping the cervix). Hold
blades apart by pressing on thumb piece and release the thumbscrew. Begin withdrawing
the speculum until cervix is released. Release pressure on thumb piece and allow blades
to close.

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Maternity (all sites) l Southern Health (2009) Clinical Competency in Vaginal Speculum Examinations (CP-MA85) Clinical Protocols a

Step 10

On completing the examination, thank the woman and suggest she redresses before
discussing the findings. Document your findings and whether swabs were taken in the
woman's medical record.
If an adverse event (actual or ‘near miss’) is associated with this guideline, document
details in the health record and complete an incident report on Riskman

1. Southern Health (2009) Clinical Competency in Vaginal Speculum Examinations

(CP-MA85) Clinical Protocols and Guidelines, Maternity
2. The Royal Australian and New Zealand College of Obstetricians and
Gynaecologists Guidelines for Gynaecological Examinations and Procedures
Statement No. C-Gen 7.November 2007
3. Southern Health (2009) Term pre-labour rupture of membranes Term Pre-labour
Rupture of Membranes (PROM) Guideline (CP-MA17) Clinical Protocols and
Guidelines, Maternity.
4. Southern Health (2009) Preterm prelabour Rupture of membranes (pPROM) initial
diagnosis and management CP-MA56) Clinical Protocols and Guidelines,
Maternity.
5. Southern Health (2009) Fetal fibronectin (fFN) Quik check test in threatened
preterm labour. (CP-MA110) Clinical Protocols and Guidelines, Maternity.

SH Policy Patient Care ACHS Clinical

Reviewer Maternity Guideline Development Group Last review date August 2008
Authoriser Maternity Executive Committee Next review date August 2010

If this is a hard copy it might not be the latest version of this document. Please see the
Southern Health site for current policies, protocols and guidelines.

Disclaimer
These clinical practice guidelines and protocols have been developed having regard to general circumstances. It is the
responsibility of every clinician to take account of both the particular circumstances of each case and the application of these
guidelines. In particular, clinical management must always be responsive to the needs of the individual woman and particular
circumstances of each pregnancy.
These guidelines have been developed in light of information available to the authors at the time of preparation. It is the
responsibility of each clinician to have regard to relevant information, research or material which may have been published or
become available subsequently. Please check this site regularly for the most current version.

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