Advice on SVE

I too am new to OB. Started in January :) It can be difficult to find the cervix sometimes... I just go very slowly and gently. If it isn't very anterior and easy to locate. I just feel left to right and then feel more posterior... I have always been able to find the cervix in term/near term pts, but it takes me some time. I try not to rush. Now preterm.... ugh. Sometimes I am not confident that a 30 weeker is closed so I have someone double check.... Not sure if that helps you. Hopefully more experienced nurses will chime in. I will be watching for their suggestions too. Good luck to you :)

It does take a lot of time and practice! I remember my first "ah ha" moment when I felt my first cervix! If your thinking it is going to be a difficult exam start off by having them make a fist and put them under their "butt" and make sure they are supine. Sometime multips have very "mushy" feeling exams making it difficult to find their cervix, just keep "climbing around" with your two fingers and you will find it! LTC feels like a nub. Everyone has their "starting point" when it comes to exams. Mine is one finger= 1cm, two fingers, tight=2cm, 2 fingers, loose= 3cm then from there its experience, I can say that 8cm for me is feeling the cervix all around the presenting part but having to "reach" around and 9cm is "loosing" the cervix on one side or another. You will also find starting points for yourself as time goes on. Do you have access to a "cervix box", your educators may have one or we have a wooden slab with holes in it for 1cm up to fully for our new residents to practice on. Hopefully this helps a little and some advice, never do a SVE on someone who is actively bleeding( you should do an ultrasound to check for placenta placement first, then a SSE) and if it is a pretermer always do a SSE and get a FFN before you do a SVE because the gel will throw off the FFN study. Good luck!!

I'll second the idea of having her place her fists under her hips-and if the cervix is really posterior sometimes that's not quite enough so I'll even just ask the patient to lift her hips up higher and usually you'll find it with no problem then. Once I figured that trick out about 12 years ago-I have never had a cervix I couldn't reach since....knock on wood!!! ; )

Best of luck to you!

I feel your pain! I have been in L&D since October and still can't get 8,9,10. Huge problem when I can't tell when they are complete!! It is so frustrating and I am waiting for my "ah-ha" moment!

I have even used a bed pan upside down covered with a towel under a mom's hips to help raise her up.

The best advice I ever had on finding a cervix on a G1 in early labor came from an attending. She said to follow the posterior wall of the lady parts as high as you can go and then turn your fingers around- the cervix should be right there.