graves speculum vs pederson

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Pederson and Graves Stainless Open-Sided Speculum - Gynex CorporationNo resultsNo resultsProcessing results.... Exam Pélvico Periprocedural Care Education and ConsentThe autonomy of patients must be respected at all times. Equipment The pelvic exam is usually done on a flat surface, typically a table with stand supports. Pelvic exam chairs, electronic tables that can tilt the patient, and tables with support for the entire lower leg are available. The speculums come in various designs and materials. The plastic spectrum is individually packaged and disposable. Many of the plastic spectra are designed with battery rechargeable lighting channels or cable lighting systems. Metallic spectra are made of several alloys that can be coated for use in surgical procedures. Pederson spectra (see image below) have a narrow flat design to accommodate a narrower vagina. These spectra are advantageous in younger, virgin or nulipare patients, as well as in older women. Pederson spectra can minimize some of the discomforts of a pelvic exam while facilitating the visualization of internal structures. Graves spectra (see image below) have a wider leaf than Pederson spectra, and their sides are also curved. Because the vaginal channel can be wider in parous women, the Graves spectrum can help in visualization. Some spectra can be used for pediatric purposes. Open-side spectra (either left or right) are available for procedures, and vaginal wall retractors are available if better visualization is required. The illumination of the rooms is rarely enough for the spectrum test. Once the spectrum is inserted, the spectrum itself can be illuminated or the lighting can be directed to the vagina (see images below). Patient PreparationAnesthesiaThe pelvic urine tests are performed in the office without any sedation. For an extremely anxious patient, oral anti-anxiety medications can be used in small doses with proper follow-up. Sometimes children or physically or mentally disabled women may require an intravenous sedation or general anesthesia exam, with appropriate consent and/or legal advice. Position Patients strip from the waist down and then wrap from the waist to the knees. Relaxation is important, and the patient must be placed in the position of dorsal litotomy. The dorsal supine lithotomy position is best achieved with the use of supports, which fit the length of the patient's leg and allow the legs to bend and kidnap. Most office foot supports require the patient to have proper muscle control to keep his or her legs upright. For patients with neurological conditions or who are anesthetized or sedated, the feet can be placed on the cane stribes of caramel, which support the legs in the lithotomy position (see image below). It is also possible that the pelvic exam is performed with supports that hold the entire leg instead of just the feet. Such support is almost essential for women with disabilities or poor musculature. Gloves should be placed or extended slightly beyond the table to provide optimal visualization and allow suitable space for the spectrum. The height of the table can be raised for the comfort of the gynecologist or can be placed in the position of Trendelenburg. The lifting of the head for about 30° helps in the relaxation of the abdominal wall, and the subsequent elevation can facilitate communication. In some cases, the Trendelenburg position can improve visualization. Most examiners sit for spectrum examination and collection of any specimens, and some prefer to present themselves to the bi-manual exam. If the uterus is very large, the examiner needs to be able to relieve the upper part of the cervix sufficiently upwards in the abdomen. The position of the knee (see image below) or the genupectoral position can be used for rectal evaluations. It is possible to help resolve the prolapse with this position, so it can be a useful alternative. If a pelvic table cannot be used, such as when the patient is hospitalized, lying or on an X-ray table for procedures, the patient can be placed with the bottoms of his feet together in a position of "rag bed" or with a twisted pan on his buttocks to facilitate the examination (see image below). Yanikkerem E, Ozdemir M, Bingol H, Tatar A, Karadeniz G. The attitudes and expectations of women regarding gynecological examination. Midwifery. 2009 Oct. 25(5):500-8. Today C, Yarnall KSH, Skinner CS, Moorman PG, Sellers D, Reid L. Pain predicts non-accession to Pap smear projection among African American women of medium age. Prev Med. 2005. 41:439-45. American College of Obstetricians and Gynecologists. Cervical Cytology Screening. ACOG Practice Bulletin No. 109. Obstet Gynecol. 2009. 114:1409-20. Storm AR, Hawkins NA, Cooper CP, Saraiya M. The pelvic exam as a detection tool: American doctors' practices. Arch Intern Med. 2011 Dec 12. 171(22):2053-4. Henderson JT, Harper CC, Gutin S, Saraiya M, Chapman J, Sawaya GF. Routine bimanual pelvic exams: practices and beliefs of U.S. obstetricians. Am J Obstet Gynecol. 2013 Feb. 208(2):109.e1-7. . Larsen M, Oldeide CC, Malterud K. Not so bad after all the experiences of female pelvic exams. Fam Pract. 1997. 14:148-52. Myers ER, Bastian LA, Havrilesky LJ, Kulasingam SL, Terplan MS, Cline KE, et al. Adnexal Mass Management. Evidence Report/Technology Assessment No.130 (Prepared by the Duke Evidence-based Practice Center under contract No. 290-02-0025.) AHRQ Publication No. 06-E004. Rockville, MD: Agency for Healthcare Research and Quality; February 2006. Wright D, Fenwick J, Stephenson P, Monterosso L. Speculum 'self-insertion': a pilot study. J Clin Nurs. 2005 Oct 14(9):1098-111. Aurora M Miranda, MD, FACOG Teaching Faculty, PGY 1 Residential Monitor, Residential Training Program, Medical Personnel, Department of Obstetrics and Gynaecology, Hospital de Penn Occidental; Associate Clinical Professor, Obstetrics and Gynaecology and Reproductive Health Sciences, Department of Obstetrics and Gynaecology, Lewis Katz Faculty of Medicine at the University of Temple Aurora M Miranda, MD, FACOG is a member of the following medical societies: , , , , , Disclosure: Nothing to reveal. Diego A Vasquez de Bracamonte, MD Resident Physician, Department of Obstetrics and Gynecology, Allegheny Health Network, Western Pennsylvania Hospital Diego A Vásquez de Bracamonte, MD is a member of the following medical societies: Peru American Medical Society Disclosure: Nothing to reveal. Christine Isaacs, MD Associate Professor, Department of Obstetrics and Gynecology, Division Head, General Obstetrics and Gynecology, Medical Director of Midwifery Services, Virginia Commonwealth University School of Medicine Christine Isaacs, MD is a member of the following medical societies: Disclosure: Nothing to reveal. Suzanne R Trupin, MD, FACOG Clinic, Department of Obstetrics and Gynaecology, University of Illinois College of Medicine in Urbana-Champaign; CEO and Owner, Women's Health Practice; CEO and Owner, Hada Cosmetic Medicine and Midwest Surgical CenterSuzanne R Trupin, MD, FACOG is a member of the following medical societies: , , , and , , , What do you want to print? Find us aboutMembershipWebMD NetworkEditions

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