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Inconsistencies in SVEs

Posted
by LNDNursila LNDNursila, RN (New) New

Hello there! I'm a fairly new RN, 14 months as an LND RN. I wanted some advice on how to tackle this situation that happened to me this morning during shift change.

Last night I had an induction for GHTN. When I checked her upon admission, she was 0 cm. After a dose of cytotec, she was 2cm and after the epidural I called her 3 cm. For me, 3 cm is being able to get 2 fingers into the cervix and spread them slightly.

Fast forward to shift change! The provider wants to go AROM the pt. When she checks her she tells the dayshift RN that she is 1.5cm/tight 2 cm and won't AROM her.

I was literally shocked. I know that vag exams are subjective but for me 1.5 cm means that you can't get a second finger into the cervix and I very well could. I can't help but feel slightly incompetent and embarrassed but I still feel like she was 3 cm in my opinion! I haven't been able to stop thinking about it. I've seen times before where doctors and even other nurses backtrack exams because they don't agree with the previous checker but I haven't had it personally happen to me. Does anyone have any advice or personal experience with this type of situation and how to navigate it going forward?

klone, MSN, RN

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 15 years experience.

I'm sorry that happened to you. Are you sure you were all the way to the inner os?

Hi klone! I definitely could get two fingers all the way to baby’s head but maybe I was stretching the cervix to make it 3 cm? Not sure.

klone, MSN, RN

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 15 years experience.

Weird. Try to let it go. Inconsistency in exams is commonplace, particularly when you have different people doing them.

labordude, BSN, RN

Specializes in L&D, OBED, NICU, Lactation. Has 15 years experience.

This will definitely fade over time, meaning how much it bugs you. Also "5 but I can stretch her to 6" is still a 5.

I had a mom once and sve was 2 and paper thin. About a half hour later OB looked at the monitor (her uc’s had picked up) and he rechecked her and said she was a 3-4 and was pissed off. He lectures me at the nurses station about accurate vag exam being crucial bc they have to trust me- blah blah. I showed him my fingers and said “this was it” (one finger tip atop another), and “I don’t know what else to tell you other than perhaps she changed her cervix”. Didn't work there very long.

I was at a home birth once and The CNM’s SVE assessment was 8. Not in labor. Declined AROM. We left! it was gonna be her 8th baby or something. About a day and a half later she was uncomfortable but not active, so accepted AROM and had a baby. Not exactly the normal, but hoping to paint the picture that cervix are not textbook creatures!

amoLucia

Specializes in LTC.

1 hour ago, ArreisBSN said:

... Not exactly the normal, but hoping to paint the picture that cervix are not textbook creatures!

I guess cervixes (cerviceses?) don' read textbooks! :roflmao: (Sorry, just had to say it!)

Seriously though I do wish that when nurses in specialty areas post, please be cautious using abbreviations or initials for stuff that is well known to you in that specialty. Most ALL of those abbrev are unknown to me. Yeah, I guess I could look them up, but that detracts from the at-the-moment read-ability of the post. Like what's GHTN, sve, uc (uterine cont?) and AROM? AROM means Active Range of Motion for physical therapy modalities.

It's just not your specialty , but also MDS, pulmn/resp and cardio (it took me FOREVER to realize what the STE in STEMI meant!).

Sorry, didn't mean to hijack your post, OP. But I do learn from others. Even if just as refresher info.

As others have said, just like in other areas, SUBJECTIVE info is just that - subjective. Like as in, "I know I just heard lung rales or positive bowel sounds, but you didn't. Timing and interpretation is everything.

klone, MSN, RN

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 15 years experience.

Sorry, when we're posting in this forum, the assumption is that we are talking to other L&D nurses. When I post in the L&D nursing forum, I'm not going to eschew abbreviations. If I'm posting in the general nursing forum, I will spell it out.

AROM artificial rupture of membranes

SVE sterile vaginal exam

GHTN gestational hypertension

UC uterine contractions

Edited by klone

amoLucia

Specializes in LTC.

klone - TY. I realize the abbreviating makes for quickness, esp when you're among yourselves. But after reading your defs, I went back to the OP and it all made sense to me! I told y'all, that these posts are opp'tys to learn something new. I was correct re UC, kinda guessed that AROM was prob some kind of induction, GHTN maybe some guess of BP what. But SVE? Never would have guessed that one.

Funny, that nite, I was also viewing some Youtube clips re history of 'Medieval Queens Who Died in Childbirth'. (Weird what I watch late at nite!) The majority of those Royales (and many, many other women) died of puerperal fever/sepsis. Knowing that childbirth techniques then were terribly Unhygienic, SVEs were most probably NOT the mode of the time! Just a fun factoid! Not all fun when underserved countries still have high maternal/fetal morbidities.

But this post has now made me want to read up on fetal distress. AN keeps the brain treadmills spinning.

Like I said, STEMIs & NSTEMIs took me awhile to figure out!

TY again.

LibraSunCNM, MSN

Specializes in OB. Has 10 years experience.

Two things I have learned over time in OB: cervixes are dynamic, and the different sizes of different providers' hands will inevitably lead to some person-to-person discrepancies. Dilation is only one piece of the labor puzzle anyway. Don't sweat it!

amoLucia

Specializes in LTC.

After reading all this, I have a question somewhat tangential to OP's - can a cervix shrink back after some dilation? Not a whole lot, but maybe an itty bit little?

And I'm asking if this has been proven objectively, rather than subjectively.

I think, like all sphincters, they can open and close. Although, I believe my colleagues would mostly disagree. Other reasons could be positional, the angle of the exam, or the woman pulling away from the examiner’s hand (the vagina is a vacuum after all), or swelling could also make it seem as though it closed. Maybe other reasons, too!

amoLucia

Specializes in LTC.

TY. Was just thinking what might have caused a true difference to OPs situational issue. That's why I asked my question - I mean muscles are contractile.

Inquiring minds wanted to know.

KTMendonca, MSN

Specializes in Labor/Delivery, PACU, and OR. Has 10 years experience.

Checking during a contraction vs. in a relaxed state can affect the SVE as well. 

You have to get to know your docs. Some are universally generous with their exams. It pisses the patient off for you to call her 3 and the doc come in a minute later to call her 5. With those docs, I tend to be very conservative and chart to the lesser of the degree of cervical change. In other words, if they could be a "stretch to 4", I will call them three. If the provider checks after me, WOW! they are making progress. LOL. Conservative checks rarely piss the doc off. Generous ones do. 

With nurses with less experience, I also see them evaluating outer rather than inner OS. That can throw off your check significantly. Make sure you go all the way through and assess the opening closest to baby's head.