Ever had cervix go down in dilitation...

  1. Hi, I need some advice please...I usually consider myself very confident in SVEs as I've over 2 yrs experience but had a bad experience when I worked a few days ago. In short, I checked a pt who had previously been 5 cms, to find that she was 9 with a contraction, 8 without. Ran around getting everything set up, etc. Rechecked her a couple hrs later (she was a SROMd prime with an epidural) when she c/o increased pain to find that she now felt no more than 7-8 with a UC. Her block wasn't effective at this point and I felt puzzled by my exam, and presenting part of the head felt different as well. I got the MD who was on and had her check. She said she was only 5-6 still. So I had to inform the family of this, all of whom are looking at me like I'm an idiot. The MD looked at me like I was an idiot. I'd have bet my life on the fact that this pt was a hair away from complete with my initial exam..so my question is- just what happened there???

    I feel so out of sorts after this experience. AND it was my first shift sans preceptor following orientation. Just NOT a great first day solo whatsoever. I feel so dismantled inside over it, I've had nightmares the last couple of nights. I just feel awful...

    Any thoughts as to what may have happened? Anyone ever experience anything like this before? Just wondering if I'm the only one...

    One Bummed Out Labor Nurse
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  2. 5 Comments

  3. by   Littlewonder
    Hey, don't feel so bad - it CAN happen. Maybe not officially, but I have definately had it happen to me (verified by repeat exams by the nurse midwife who felt the same thing!) There are several possible senario's: she could have had some swelling going on, she could have had an undiagnosed latex allergy (have had happen, her cervix would close more with each exam due to swelling,) she could have had less pressure of the presenting part on the cervix - thus causing a reduction in dialation. One thing that would be interesting to see would be to try some position changes to see if more pressure on the presenting part would return the cervix to its prior dialation. I do think a change in head position could possibly affect things too, due to change in pressure, etc.
    I don't know the official take - but I do know it happens. I am sorry you had such a hard and frustrating experience. Too many people fault the nurse if things don't go the way they think they should. We can not make the cervix do anything - we just report what happens. And there is also some human error factor and difference between people too. Maybe with the last exam the MD's response was 5-6 when actually she was a good 7. How many times have each of us had a MD do a totally different vag exam and then we compare with the chart (or experience) and know that their fingers are blind!!! Hugs, go in and have a great day next shift - don't let this keep you down.:icon_hug:
  4. by   SmilingBluEyes
    Yes---theoretically---- it does happen, sometimes. And it's not always a mistake or a difference in opinion between nurses or nurse and doctor----- but swelling that can do this. For example, not long ago, for a patient of mine, a rim of cervix became a 7-8 due to swelling and mal-presentation of the fetal presenting part. (baby was acynclitic). So yes it CAN happen. Dilation can be "reversed".

    Also, it can happen when you check during a contraction versus between them, that you have a difference in noted dilatation. Depending on the position or station of the vertex, you can feel a difference there as well. Therefore, it's important to note whether you have checked a person between uterine contractions or during them. Also, if a person's water breaks, the cervix can seem to "shrink" at times a centimeter or two afterward, due to lack of stretching by the amnion.

    So yes, you can have a "reversal" of dilation happen and it not be simply a matter of varying opinions and persons examinations!
  5. by   SmilingBluEyes
    I often term very friable cervices a "stretchy 8" or "8-9" when a physician examining the same woman will call that a 7 or 8. A stretchy cervix can feel different to different people---and again, checking between uterine contractions versus during them, can make a difference.

    Difference of opinion between you and dr? Hey---No biggie. You need only to chart what YOU note and let them chart what they do. It happens all the time! It is NOT an exact science anyhow---but meant as a tool to assess progress. In laboring women w/o anesthesia, you will find you need not examine nearly as much (or at all) to assess progress, anyhow.

    Here is a story that may help you out:

    I had a dr who demanded I check after her to "teach me what a cervix of 4 feels like" when I had a very fast-progressing grand multip come in. She was very irritated I called her to come in immediately when the patient had presented a 7-8------Anyhow, she called her a "4" (and charted that in her progress note). She said, "I would like you to check behind me, and you will see she is only a 4 and you called me too soon".

    I checked and said, "nope, I call that an 8, and that is what I am charting" and set her up for delivery. I also told the dr to hang around, she would be delivering in probably less than 30 min. She huffed out and sure enough, the patient was ready to push in 15 minutes and the dr had to rush back in, fully in her Sunday church wear, to do a messy and fast delivery---no time to put on her gown or gloves, too bad. SOMEtimes nursing has its rewards....I had to laugh and rub that in "just a bit". She never again demanded I "learn how to check a cervix" after that.

    DO remember this about cervical exams. Less is more and numerous VE's can lead to infection---so check judiciously and rarely, if at all possible.

    Also, It's just a number---sometimes, one we put WAY too much emphasis on. Watch your patient and fetus for real signs of change and progress.
    Last edit by SmilingBluEyes on Dec 26, '05
  6. by   ShannonB25
    Thanks for the advice, ladies, and for listening. I'm going to chalk this up to experience I suppose and try not to lose heart over it. I love my job and I won't let this stand in my way. Thanks again for the support. And I've committed your advice to memory as well as possible scenarios.

    Hugs to you all!!!
  7. by   JentheRN05
    Had this happen once in my short term of L&D. The lady ended up have 2 cervixes. We were all stymied until a 20 year vet came in and checked her and felt both!
    Interesting to say the least.

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