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PS (Per Speculum) aur PV (Per Vaginum) Examination

🔴 PS Examination - KISME KARE (Indications)

Gynecological Conditions

Obstetric Conditions

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🔴 PV Examination - KISME KARE (Indications)

Gynecological

• Pelvic pain - adnexal tenderness, cervical excitation (PID, ectopic rule out)
• Adnexal mass - size, consistency, mobility, tenderness assess
• Uterine fibroid - size, consistency
• Ovarian cyst - bimanual palpation
• Suspected ectopic pregnancy - cervical excitation tenderness
• Endometriosis - uterosacral nodularity, fixed retroverted uterus
• Pre-operative assessment
• Cervical incompetence - cervical os feel karna
• Post-menopausal bleeding - uterine size, tenderness

Obstetric

• Active labour - cervical dilation, effacement, station assess
• Prolonged labour - progress check
• PROM confirmation
• Malpresentation confirm - presenting part feel karna
• Cord prolapse - emergency mein
• Placenta praevia (low-lying) - NAHI karte, lekin double set-up mein carefully

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❌ PS Examination - KISME NA KARE (Contraindications)

⚠️ Antepartum haemorrhage mein: PS exam allowed hai (carefully), lekin PV bilkul NAHI jab tak placenta praevia rule out na ho ultrasound se

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❌ PV Examination - KISME NA KARE (Contraindications)

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📌 Key Clinical Rule - याद रखने वाला

"APH mein - PS haan, PV nahi" Antepartum haemorrhage mein speculum se dekhna allowed hai (cervical cause rule out karne), lekin PV karna FORBIDDEN hai jab tak ultrasound se placenta praevia rule out na ho.

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Summary Table

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PS (Per Speculum) aur PV (Per Vaginum) Examination

✅ PS Examination - KISME KARE (Indications)

Gynecological

Obstetric

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✅ PV Examination - KISME KARE (Indications)

Gynecological

• Pelvic pain - adnexal tenderness, cervical excitation (PID, ectopic)
• Adnexal mass - size, consistency, mobility
• Uterine fibroid - bimanual assessment
• Ovarian cyst
• Ectopic pregnancy (suspected) - cervical excitation tenderness
• Endometriosis - uterosacral nodularity
• Post-menopausal bleeding
• Pre-operative assessment

Obstetric

• Active labour - dilation, effacement, station
• Prolonged labour - progress check
• Malpresentation - presenting part feel karna
• Cord prolapse (emergency)

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❌ PS Examination - KISME NA KARE (Contraindications)

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❌ PV Examination - KISME NA KARE (Contraindications)

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🔑 Sabse Important Clinical Rule

"APH mein - PS haan, PV nahi"

• APH mein sterile PS allowed hai (cervical cause rule out karne ke liye)
• PV bilkul forbidden jab tak ultrasound se placenta praevia rule out na ho

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Quick Summary Table

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PS (Per Speculum) & PV (Per Vaginum) Examination

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✅ PS KISME KARE - Indications

Gynecological

• Vaginal discharge - source, character dekhna
• Abnormal uterine bleeding - DUB, IMB, PCB, PMB
• Cervical erosion / ectropion / cervicitis
• Cervical polyp - visualize + remove
• Pap smear - cervical cancer screening
• Prolapse - cystocele, rectocele, uterine prolapse degree
• IUCD string check
• STI swab lena
• Foreign body vagina mein
• Colposcopy / cervical biopsy

Obstetric

• APH - sterile speculum (USG ke baad)
• PROM - liquor pooling confirm karna
• Preterm labour - cervical os status
• Cervical cerclage (cervical incompetence)

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✅ PV KISME KARE - Indications

Gynecological

• Pelvic pain - adnexal tenderness, cervical excitation
• Adnexal mass - size, consistency, mobility
• Fibroid uterus - bimanual assessment
• Ectopic pregnancy - cervical excitation tenderness
• Endometriosis - uterosacral nodularity
• Ovarian cyst
• Post-menopausal bleeding
• Pre-operative assessment

Obstetric

• Active labour - dilation, effacement, station, position
• Prolonged labour - progress monitor
• Malpresentation - presenting part feel karna
• Cord prolapse - emergency

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❌ PS KISME NA KARE - Contraindications

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❌ PV KISME NA KARE - Contraindications

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🔑 MOST IMPORTANT RULE - Exam ke liye

"APH mein - PS haan ✅, PV nahi ❌"

• Antepartum haemorrhage mein sterile speculum kar sakte hain
• PV bilkul nahi jab tak USG se placenta praevia rule out na ho
• Reason: PV se placenta dislodge ho sakti hai = life-threatening bleed

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📊 Quick Revision Table

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PS & PV Examination - Kaise Likhte Hain (Case Writing)

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📝 PS EXAMINATION FORMAT

✅ NORMAL Case mein likhte hain:

PS Examination:
- Vulva and perineum: Healthy, no lesion
- Vaginal walls: Healthy, no discharge, no prolapse
- Cervix: Healthy, pink, smooth, os closed
- No cervical erosion / ectropion
- No bleeding / discharge through os
- Vaginal fornices: Free, non-tender

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🔴 ABNORMAL Case mein likhte hain:

PS Examination:
- Vulva: Healthy
- Vaginal walls: Healthy
- Cervix: Unhealthy, reddish area around os
  → Cervical erosion present (size mention)
- Mucopurulent discharge through os +
- Fornices: Free, non-tender

PS Examination:
- Perineum: Old perineal tear present
- Vaginal walls: Cystocele + / Rectocele +
- Cervix: Descends to introitus on straining
  → Uterovaginal prolapse - 2nd degree
- Os: Parous (open)

PS Examination (Sterile):
- Vulva: Blood stained
- Vaginal walls: Blood present
- Cervix: Os closed / Os open (mention)
- Active bleeding from os: Present / Absent
- No laceration seen

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📝 PV EXAMINATION FORMAT

✅ NORMAL Case mein likhte hain:

PV Examination:
- Introitus: Admits 2 fingers
- Vaginal walls: Normal, no tenderness
- Cervix:
  → Position: Central / Anterior / Posterior
  → Consistency: Firm (non-pregnant) / Soft (pregnant)
  → Length: Normal (not effaced)
  → Os: Closed (nullipara) / Admits fingertip (parous)
  → Cervical movement tenderness (CMT): Absent
- Uterus:
  → Position: Anteverted, Anteflexed (AVF)
  → Size: Normal (8 x 4 x 3 cm) / bulky
  → Surface: Smooth / regular
  → Consistency: Normal
  → Mobility: Mobile
  → Tenderness: Absent
- Adnexa (Fornices):
  → Bilateral fornices: Free, non-tender
  → No mass felt
- Pouch of Douglas (POD): Empty, non-tender

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🔴 ABNORMAL Case mein likhte hain:

PV Examination:
- Introitus: Admits 2 fingers
- Vaginal walls: Normal
- Cervix: Firm, os closed, no CMT
- Uterus:
  → Enlarged - 14 weeks size
  → Irregular surface (nodular)
  → Hard consistency
  → Mobile
  → Non-tender
- Fornices: Free, non-tender
- POD: Empty

PV Examination:
- Introitus: Admits 2 fingers
- Vaginal walls: Tender
- Cervix: Soft, os closed
  → CMT: POSITIVE (Chandelier sign +)
- Uterus: Slightly enlarged, tender
- Fornices:
  → Bilateral adnexal tenderness +
  → Right fornix: Fullness felt (? pyosalpinx)
- POD: Tender

PV Examination (In labour):
- Introitus: Admits 2 fingers
- Presenting part: Vertex / Head
- Cervix:
  → Dilation: 6 cm
  → Effacement: 70%
  → Consistency: Soft
  → Position: Central
- Station: -1 / 0 / +1
- Membranes: Intact / Ruptured
- Moulding: Grade I / II
- Caput: Absent / Present

PV Examination:
- Cervix: Healthy, os closed, no CMT
- Uterus: Normal size, AVF, mobile
- Left fornix:
  → Mass palpable - 8x6 cm
  → Cystic consistency
  → Smooth surface
  → Mobile
  → Non-tender
- POD: Non-tender

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🔑 Key Points - Exam mein yaad rakhna

Tip: Har case mein pehle NORMAL baseline likhke phir abnormality mention karo - examiner ko clear picture milti hai ✅

PS & PV - Exact Case Format (Short Terms)

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📋 PS EXAMINATION

NORMAL

P/S - Cusco's speculum passed under aseptic conditions.
- Vagina    : Healthy / NAD
- Cervix    : Healthy, pink, smooth
- Os        : Closed (Nulliparous) / Parous
- Discharge : Nil
- Bleeding  : Nil
- Fornices  : Free, non-tender

ABNORMAL

P/S - Cusco's speculum passed under aseptic conditions.
- Vagina    : Healthy / Discharge +
- Cervix    : Unhealthy / Erosion + / Polyp +
- Os        : Closed / Open / Dilated _cm
- Discharge : Mucopurulent / Blood stained / White
- Bleeding  : Present / Absent
- Fornices  : Full / Tender

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📋 PV EXAMINATION

NORMAL

P/V -
- Introitus    : Admits 2 fingers
- Vagina       : NAD
- Cervix       : Central / Ant / Post
                 Firm / Soft
                 Uneffaced / Effaced
                 Os - Closed / _cm dilated
                 CMT - Absent
- Uterus       : AVF / RVF
                 Normal size / _wks size
                 Smooth / Irregular
                 Mobile / Fixed
                 Non-tender / Tender
- Fornices     : Free, non-tender (B/L)
- POD          : Empty, non-tender

ABNORMAL

P/V -
- Introitus    : Admits 2 fingers
- Vagina       : Tender / Discharge +
- Cervix       : Soft / Firm
                 Os - Closed / Open
                 CMT - POSITIVE ✓
- Uterus       : Bulky / _wks size
                 Irregular / Nodular
                 Fixed / Mobile
                 Tender +
- Fornices     : R/L - Full + / Tender +
                 (mass: size, consistency, mobility)
- POD          : Full / Tender +

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⚡ Commonly Used Short Terms

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📝 Obstetric PV (Labour) Short Format

P/V (In Labour) -
- PP          : Vertex / Breech
- Cervix      : _cm dilated
                _% effaced
                Soft / Firm
                Central / Post
- Station     : -2 / -1 / 0 / +1 / +2
- Membranes   : Intact (I) / Ruptured (R)
- Moulding    : 0 / + / ++ / +++
- Caput       : Absent / +
- Liquor      : Clear / Meconium stained

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Exam Tip: Pehle line mein likho "P/S - Cusco's speculum passed" ya "P/V - done under aseptic precautions" - yeh mandatory opening line hai ✅

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