Vag Exams & Dilation

Published

I'm a new grad RN in L&D. I seem to have more difficulty determining cervical dilation when the pt is 8cm or more. How can you tell the difference between 9cm and 10cm. How do you know when a patient's complete? When I feel I can't even tell the difference when a nurse said the pt. was 9-10 (9.5). What is an anterior lip? Station is also difficult for me because I can't ever feel the ischial spines. Any tips/suggestions? Sorry, I just feel lost. Thanks.

Up Vote Up Vote ×
Specializes in L&D.

10 cm's you don't feel ANY cervix, at that time they would be complete. An anterior lip is when you can feel just a "lip" of cervix on the anterior, and no where else. I would probably call someone 9-10 if they had an anterior lip. The spines are difficult to feel, I usually run my fingers along the insides where I know they should be. Practice is all I can say about that one.

Up Vote Up Vote ×

When the patient is 8 or more, I feel around the whole head and estimate how much is left of the cervix. So one fingertip=9cm, almost 2 fingertips=8 cm.

It is also not uncommon for the cervix to be complete on one side and 8 or 9 cm on the other. In that case position the mom on the same side. Hope that helps!

Up Vote Up Vote ×
When the patient is 8 or more, I feel around the whole head and estimate how much is left of the cervix. So one fingertip=9cm, almost 2 fingertips=8 cm.

It is also not uncommon for the cervix to be complete on one side and 8 or 9 cm on the other. In that case position the mom on the same side. Hope that helps!

Just to clarify, position them on the side where there is still cervix?

Up Vote Up Vote ×
Specializes in PERI OPERATIVE.

The cervix can sometimes be uneven on the sides. The sides of the head that it. I always explain it like a turtleneck coming over your head. If you pull harder on one side then there will still be a part of the turtleneck that is still coming around your head...does that make any sense?

Also regarding the cm and determining what is what:

When a cervix is completely dialated you can't feel it any more. I don't usually call it "10" cause I can stretch my fingers out to 10 cms and still feel cervix.

Up Vote Up Vote ×
Specializes in Perinatal only!.

Here's my two cents about cervical examinations for new nurses. When you are beginning your practice, focus first on just ballparking the cervical dilation. Is she three, seven or ten cms? Then go for finesse. In the end, it doesn't matter if I say she's eight and you say shes nine. (Keep in mind that if I say she's eight and you says shes ten, one of us is wrong. ) The one crucial examination to be certain of is 10 (or "complete" or "fully" depending on what region you work in) AND low enough to start pushing.

I know that the textbook definition of station is where is the cranium in relation to maternal ischeal spines. Two thoughts on this one. I bet most experienced labor and delivery nurses never think about an ischeal spine. Second, the epidemic of obesity in this country makes the notion almost obsolete. I can't palpate an ischeal spine on more than half of my patients! Minus three is "pretty high", 0 is "we're making progress", plus two is where I will consider starting to push if patient is epiduralized, plus three means that I'm thinking about how far away the Doctor lives and crowning means I'm putting on gloves and wishing I had called the doctor sooner.

And what really matters is "did you feel that small piece of pulsating cord" during the exam.:specs:

Up Vote Up Vote ×

Thanks for your replies!:wink2: Maybe I'm thinking too hard about this but if 10cm or complete is when there is no cervix, how can someone be 100% effaced (cervix thinned out) and still be 6cm dilated? That's the part that's confusing me. Doesn't 100% effaced mean you can't feel cervix? Thanks.

Up Vote Up Vote ×
Specializes in L&D.
Thanks for your replies!:wink2: Maybe I'm thinking too hard about this but if 10cm or complete is when there is no cervix, how can someone be 100% effaced (cervix thinned out) and still be 6cm dilated? That's the part that's confusing me. Doesn't 100% effaced mean you can't feel cervix? Thanks.

Two separate things....effacement is the thinning out of the cervix, so if you are 100% thinned out (or effaced) your cervix is paper thin.

If you are dilated 10 cms you are "complete" or "fully" which means you can't feel ANY cervix.

Up Vote Up Vote ×
Thanks for your replies!:wink2: Maybe I'm thinking too hard about this but if 10cm or complete is when there is no cervix, how can someone be 100% effaced (cervix thinned out) and still be 6cm dilated? That's the part that's confusing me. Doesn't 100% effaced mean you can't feel cervix? Thanks.

100% effaced means that the cervix is paper-thin...it's no longer thick. You will still only be able to spread your fingers 6 cms apart.

Up Vote Up Vote ×

I got sidetracked in the middle of posting... hit submit... almost identical answer in the meantime from someone else... I sound like the kid in class who repeats everything! :imbar

Up Vote Up Vote ×
+ Join the Discussion