Cervical Assessment of the Laboring patient is a skill that is important for effective labor management, but may have limited opportunities for learning in the actual clinical setting. Thus, some medical students may not achieve competency prior to graduation. Assessing a learner’s ability requires allowing them to perform actual digital exams on patients in the office or on labor and delivery, with an experienced practitioner confirming their exam. It is important to understand the changes that occur in the cervix and vagina during labor leading to delivery.
Skills training in cervical assessment requires prior knowledge of:
NOTE: This entire module is also available in PDF Format.
This clinical skills module provides a standardized framework for teaching learners how to assess the cervix in labor utilizing standardized cervical models. Following participation in this module, students should demonstrate the following learning outcomes:
Reliance upon clinical expertise as a gold standard for determining accuracy of cervical assessment skill is under investigation. Experienced clinicians accurately assessed dilation only about 50% of the time. Accuracy appears to decrease with advancing cervical dilation and may vary with the type of simulator model, with soft models providing a more realistic, but less accurate, examination simulation than hard models. Thus, learners may benefit from learning on firm models first.
We suggest that cervical model simulators be used to teach the initial clinical intrapartum vaginal exam. Below is a photograph of low resource clay models.
The following checklist may be used as a component of the training session and/or as a component of a performance assessment as part of an objective structured clinical examination.
|Describe the benefits, risks, and indications for cervical assessment|
|Describe the technique of properly assessing dilation, effacement, and station.|
|Explain procedure to patient|
|Put on gloves in a sterile fashion|
|Use lubricant on two fingers that will be used to perform vaginal examination|
|Use non-dominant hand to separate labia|
|Use two fingers of the dominant hand to assess the cervix|
|Assess presenting part|
|Accurately assesses cervical dilation|
|Accurately assesses cervical effacement|
|Demonstrates appropriate sterile technique throughout examination|
The provided checklist can be used for performance assessment.
The instructor indicates that the student will be demonstrating proper cervical assessment technique. The instructor asks the student to discuss benefits and risks for intrapartum cervical assessment.
The instructor asks the student to describe and then perform the steps in an intrapartum vaginal examination.
The instructor asks the student to perform the vaginal exam. A cervical model, sterile gloves, and lubricating jelly should be available.
Following completion of appropriate didactic or self-directed background learning, students should participate in a mentored hands-on practice session/lab. The practice session should include a demonstration of the following skills:
Models may be hand-made or purchased from commercial vendors. Some of the available models are listed below.
|Model Name||Manufacturer||Approximate cost|
|Hand made sculpting clay||Any modeling clay and softballs||<$50|
|Cervical effacement and dilatation model||Health Edco||$120-566|
|Labor Stages model||3B Scientific||$500|
|Cervical dilatation/Effacement Simulator||Life/Form||$895|
|Cervical Examination and Childbirth Simulator||Nucleus||$750-1000|