Use of a vaginal speculum and taking a vaginal swab

Use of a vaginal speculum and taking a vaginal swab

Image described by caption and surrounding text.

The vaginal speculum has been in use for over 2000 years. It is used for both obstetric and gynaecological examinations. Midwives will carry out examinations using a speculum in certain circumstances during pregnancy and need to be competent in this skill.

The insertion of the speculum can be uncomfortable and may cause anxiety or embarrassment for some women. The level of anxiety may also be related to the reason for the examination so this should be taken into consideration. It is essential the midwife gives a full explanation of the indications for the speculum examination and procedure so as to obtain informed consent. Any queries or anxieties the woman has must be addressed at this time. It is probable that the woman has at some point had a cervical smear, which is obtained using a speculum, so it can be useful to use this as part of the explanation of the procedure so the woman knows what to expect.

A Cusco vaginal speculum is used for examination in pregnancy. Figure 53.1 shows the speculum with blades open; Figure 53.2 shows the blades closed. In pregnancy the midwife should use an aseptic technique if the membranes have ruptured; sterile gloves should be used. The speculum blades will require lubrication prior to use and the woman needs to be positioned correctly as described below.

The indications for speculum examination during the antenatal period are given in Box 53.1. Equipment required is listed in Box 53.2.

Examination procedure

Vaginal swab

A vaginal swab can either be a high vaginal swab (HVS) or low vaginal/vaginal swab (LVS). A speculum must be used to enable an HVS to be taken (Evans and Morgan, 2012). This is then sent to the laboratory for microscopy and then culture and sensitivity if indicated by microscopy examination. It can be used for diagnosis of vaginal infections such as bacteria vaginosis, Group B streptococcus and candidiasis. Some texts do not specify HVS, only vaginal swab and also advocate the woman being able to take the swab herself. Care must be taken to ensure the swab is not contaminated before placing it into the vagina to ensure that organisms detected are vaginal rather than from the perineum or anus.

The swab should be taken and then placed in the transport medium within the receiver provided, adhering to local policy and procedure. The transport medium is normally Amies transport medium with charcoal. The purpose of the charcoal is to protect the bacteria from the light and the transport medium provides a moist environment to keep the bacteria alive during transport to the laboratory. It is the responsibility of the midwife to ensure that the swab is clearly labelled and documented in the notes so that the result can be followed up and appropriate treatment given if required.

Jun 19, 2019 | Posted by in MIDWIFERY | Comments Off on Use of a vaginal speculum and taking a vaginal swab

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