Obstetric Exam

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent	0	1
Asks patient if they are feeling well and if they’ve observed any foetal movements today	0	1
Informs patient that a chaperone will be present	0	1
Asks patient to lie flat with some left tilt if required	0	1
Washes hands	0	1
Exposes patient’s abdomen from xiphisternum to the pubic symphysis	0	1
General inspection around bed for medication (e.g. metformin) and to see if patient appears comfortable	0	1
Inspects abdomen looking for symmetry of abdominal distension, surgical scars (e.g. pfannestiel scar or laproscopic scar), eversion of the umbilicus, linea nigra, striae gravidarum, striae albicans, any foetal movements)	0	1
Asks patient if they have any pain anywhere	0	1
Palpates abdomen making note of uterine size and measures symphysio-fundal height (tape measure down so blind measurement) comparing this to expected.	0	1	2
Palpates for liquor volume and comments on volume. Notes causes of reduced (dehydration, foetal abnormalities) or increased (gestational diabetes, foetal abnormalities) volume	0	1	2
Palpates foetus, identifying number present and lie (longitudinal, transverse, oblique)	0	1
If longitudinal, determines the presentation (cephalic or breech)	0	1
If longitudinal and cephalic, determines engagement quoting this in how many fifths are palpable	0	1
Ausculates over the anterior shoulder for the foetal heartbeat using Pinard stethhoscope. When auscultating, should not be holding pinard with hands and should be feeling maternal pulse	0	1
Checks for ankle/sacral oedema	0	1
Requests urinalysis and maternal blood pressure	0	1
Summarises appropriately with only key findings	0	1
Offers appropriate differential diagnoses and explains these to patient	0	1
Offers next steps according to guidelines (e.g. pre-eclampsia: senior review, whether to admit patient and give antihypertensives and whether to deliver baby)	0	1
Patient global score	0	1	2

Bimanual (Vaginal) Exam

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent	0	1
Asks patient to empty bladder before commencing examination and also if they require a smear (this should be done before bimanual exam)	0	1
Informs patient that a chaperone will be present	0	1
Informs the patient that it is possible to lock the room to maintain privacy	0	1
Asks patient to undress behind the curtain from the waist down and lie flat on the couch covering themselves with a towel	0	1
Collect equipment (gloves, lubricant)	0	1
Washes hands	0	1
Expose patient and ask them to bend their knees, bringing their feet to their bottom and let their knees drop either side	0	1
Inspect the external genitalia for any discharge, scars, cysts, irritation, proplapse or any other abnormalities	0	1
Ask the patient if they have any pain and inform the patient that you are about to begin the examination and that they can tell you to stop at any time	0	1
Applies lubricant to two gloved fingers. Introduces fingers with palm facing towards the patient’s right if using your right hand	0	1
Palpates the vaginal wall for tenderness and masses	0	1
Palpates the cervix feeling for any masses or tenderness (excitation). Comment on the surface, consistency and mobility (should be like tip of nose)	0	1
Palpate the abdomen to identify the top of the uterus whilst pushing it anteriorly from inside. Comment on the size and whether the uterus is anteverted or retroverted (in the latter you need to feel palpate deeper on the abdomen). Feel for any masses and the mobility of the uterus as well as for tenderness	0	1	2
Palpate the adenexae. With your gloved fingers, feel either side of the cervix as deep as possible whilst with your palpating hand, roll the iliac fossa towards your hand. Attempt to catch the ovaries which should normally be impalable	0	1
Remove your gloved fingers and with your back to the patient, inspect your fingers for blood or discharge	0	1
Allow the patient privacy and tissues to clean the area and redress	0	1
Dispose of all waste in the appropriate bin	0	1
Summarises appropriately with only key findings	0	1
Offers appropriate differential diagnoses if any abnormalities noted and explains these to patient	0	1
Offers next steps according to guidelines (e.g. pre-eclampsia: senior review, whether to admit patient and give antihypertensives and whether to deliver baby)	0	1
Patient global score	0	1	2

Cervical Smear & Exam

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent	0	1
Asks patient if they have had any vaginal discharge, pain or itching and whether they’ve had a previous smear and their experience. Also ask if patient has previously given birth and is sexually active, informing them that these questions allow you to select an appropriately sized speculum	0	1	2
Informs patient that a chaperone will be present	0	1
Informs the patient that it is possible to lock the room to maintain privacy	0	1
Asks patient to undress behind the curtain from the waist down and lie flat on the couch covering themselves with a towel	0	1
Collect equipment (gloves, speculum, collecting pot, brush, lubricant). Check that equipment is in date	0	1
Washes hands	0	1
Expose patient and ask them to bend their knees, bringing their feet to their bottom and let their knees drop either side	0	1
Inspect the external genitalia for any discharge, scars, cysts or any other abnormalities	0	1
Ask the patient if they have any pain and inform the patient that you are about to begin the examination and that they can tell you to stop at any time	0	1
Open the speculum and check it is functional	0	1
Apply lubricant only to the sides of the speculum to avoid covering the cervix with lubricant	0	1
Insert the speculum slowly parting the lips of the labia with your non-dominant hand. Insert horizontally then turn vertically as you progress. Then when it is as far in as possible, warn the patient before gently opening the blades and bring the cervix into view. Lock the speculum in this position by tightening the screw	0	1	2
Inspect the cervix for any abnormalities including irritation or lesions	0	1
Sample the cells by introducing the tip of the brush into the cervix and turn 5 times clockwise. Remove the brush and bang the tip 10 times on the bottom of the collecting pot	0	1
Remove the speculum slowly with or without rotating it. Be careful not to clamp the cervix when closing the blades or pull any pubic hair	0	1
Allow the patient privacy and tissues to clean the area and redress	0	1
Label the bottle and dispose of all waste in the appropriate bin	0	1
Summarises appropriately with only key findings	0	1
Offers appropriate differential diagnoses if any abnormalities noted and explains these to patient	0	1
Inform the patient to expect the results by post and that their GP will call if there is any required follow up. Otherwise they will need another routine smear in 3 years. Remind them again that the purpose of the smear screening programme is to look for precancerous changes to treat before any cancer develops	0	1
Inform the patient it is normal to occasionally have a little spotting for a day or two following a smear but to report any heavy or painful discharge	0	1
Patient global score	0	1	2