VAGINAL DELIVERY

STEPS
1. Introduces oneself to the patient.
2. Explains the procedure.
3. Supports the perineum as the head extends.
4. Wipes blood and mucus from the baby’s face.
5. Supports the baby’s head by holding the sides of neck.
6. Performs downward traction.
7. Executes upward traction.
8. Slides right hand along the back of the baby until he/she grasps the lower
extremities.
9. Holds the baby upside down with the navel on the same level as the introitus.
Places baby over maternal abdomen or chest.
10. Clamps the cord with 2 clamps
11. Cuts the cord between 2 clamps.

INSPECTION OF THE PLACENTA

STEPS
1. Inspects the umbilical cord and counts the number of blood vessels.
2. Identifies the insertion of the umbilical cord.
3. Inspects the fetal surface of the placenta.
4. Lifts placenta by the cord and inspects the membranes.
5. Inspects the maternal surface of the placenta and determines completeness of
cotyledons.
EPISIOTOMY AND REPAIR

STEPS
1. Inspects the vagina and cervix for any lacerations.
2. Places first suture 1 cm above the angle of the episiotomy wound.
3. Closes the vaginal mucosa and submucosa using continuous interlocking sutures
up to the hymenal ring.
4. Reapproximates the cut hymenal ring and ties with a square knot.
Cuts the end suture properly.
5. Closes the fascia and muscles of the incised perineum using figure of eight, making
sure the rectal mucosa is being spared and hemostasis is obtained.
6. Proceeds with simple continuous suture after placing a knot near the hymenal ring
down to the end of episiotomy.
7. Performs continuous subcuticular suture carried upward to close the skin.
8. Ties the final knot approximately to the hymenal ring. Cuts end suture 1 cm from
the knot.
9. Performs rectovaginal examination to check for
a. any sutures going through and through the rectal mucosa
b. vaginal hematoma
c. retained sponge
TMG

STEPS
1. Introduces oneself to the patient.
2. Explains the procedure.
3. Drapes patient correctly.
4. Inspects the external genitalia.
5. Adjusts lights. Put on gloves.
6. Lubricates the speculum with water.
7. Depresses the posterior vaginal wall with a gloved hand.
8. Inserts the speculum obliquely to avoid the urethra.
9. Rotates the speculum blade along the transverse diameter of the vagina.
10. Opens the speculum when the blades are fully inserted.
11. Visualizes the cervix.
12. Acquires adequate samples from the cervix and spread over 3 separate slides.
13. Applies immediately the appropriate reagents on each of the 2 specimens.
a. NSS for Trichomonas
b. KOH for Monilla
c. No reagent for Gram stain
14. Removes the speculum in oblique manner.
PELVIC EXAMINATION

STEPS
1. Introduces oneself to the patient.
2. Explains the procedure and the reason for the procedure.
3. Asks the patient to void to empty her bladder.
4. Instructs patient to assume a dorsolithotomy position..
5. Places drapes properly.
6. Adjusts lighting.
7. Inspects external genitalia.
8. Palpates external genitalia.
9. Lubricates the speculum with water.
10. Depresses the posterior vaginal wall with a gloved hand.
11. Inserts the speculum obliquely to avoid the urethra.
12. Rotates the speculum blade along the transverse diameter of the vagina.
13. Opens the speculum when the blades are fully inserted.
14. Visualizes the cervix.
15. Removes the speculum in an oblique manner.
16. Lubricates examining finger.
17. Performs bimanual exam.