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Rapid Responses: Rapid Responses published:
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Stirups in the labour ward
- Patji Alnaes-Katjavivi (22 July 2006)
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Vulnerability and comfort during vaginal speculum examination
- Keith R Stewart (24 July 2006)
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Routine gynaecological examination does not require stirrups
- Jai B Sharma MD MRCOG, Sameer Chadha , Medical Student , MAM College New Delhi (8 August 2006)
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Patji Alnaes-Katjavivi, hospital doctor The Women's Center, Ullevaal University hospital, Oslo, Norway.
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I quote, "Many US obstetricians are concerned that these "difficult" non-supine positions without stirrups could become problematic if a shoulder dystocia develops". Encountering a shoulder a dystocia is an indication for getting the woman OUT of the stirrups and flat on her back in the Mc Roberts position. Competing interests: None declared |
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Keith R Stewart, Retired GP Retired ME15 9ST
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The sketch in this article positions the woman for speculum examination at the foot of the couch, presumably so that the examiner stands (or sits) facing the woman's vulva - a North American device. In the UK we have prefered to stand at the side of the examination couch with the woman's head on the pillow at the head-end of the couch. I believe this is a more relaxed position for the woman and one that will cause less feeling of vulnerability. If this position were to be responsible for a greater number of inadequate cervical smears we would have know about it long ago. Keith Stewart Competing interests: None declared |
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Jai B Sharma MD MRCOG, Assistant Professor of Obstetrics and Gynaecology All India Institute of Medical Sciences , New Delhi, Sameer Chadha , Medical Student , MAM College New Delhi
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The editorial by Wendy Brooks Bar on vaginal examination without stirrups and the article by Seehusen et al on improving women's experience during speculum examination at routine gynaecological visits: randomised trial raise certain questions. There is no doubt that the dorsal position with stirrups is the best position for performing major and minor gynaecological surgeries as it ensures the proper position with buttocks at the edge of the table for proper insertion of Sim's speculum for posterior vaginal wall retraction and easier performance of surgeries. However, for routine outpatient gynaecological examinatins including Pap smears and outpatient endometrial aspirate with small Karman's cannula ( 4 number) and for endometrial biopsy for infertility patients using endometrial biopsy curette, the simple dorsal position without stirrups is enough. For outpatient speculum examination without surgery Cusco's speculum is adequate and does not require bringing down the patient to the edge of the table and an assistant is not even required as the Cusco's speculum is self retaining. It is much more convenient for the patient and is adequate for most out patient speculum examinations. Even satisfactory Pap smears can be taken with it. However, for endometrial aspirate or biopsy and for Pap smears, it is advisable to bring the patient at the edge of table and she can bend her knees and take them towards her head. Then with the help of assistant, the posterior vaginal wall is retracted using appropriately sized Sim's speculum and anterior vaginal wall is retracted with the anterior vaginal wall retractor (elevator) and the procedure is successfully completed. In our experience in outpatient speculum examinations stirrups are not required as patients feel better and more comfortable without their use. However, when surgeries other than quoted above are required and in obstetrics for episiotomy and in presence of shoulder dystocia, lithotomy position with legs in stirrups is definitely the best position for optimum results and should always be used without hesitation. Competing interests: None declared |
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