Reference Manual - IARC Screening Group

Performing Breast and Pelvic ExaminationsIf you cannot feel the uterus, it may be either horizontally directed or,more likely, retroverted.• To check this, you will need to either:• move the uterus upward: place the fingers of the pelvic handunder the cervix and gently lift up (anteriorly) (Figure G-23), or• push down more deeply with the fingers of your abdominal hand.Figure G-23. Feeling a Retroverted Uterus• If you still cannot find the uterus, move your fingers to each side ofthe cervix and press inward as far as you can without causingdiscomfort. Then press downward with your other hand as deeply aspossible.If these maneuvers do not help, it may be necessary to do a rectovaginalexamination (see page G-28).• While palpating the uterus, check for the following:• Size: The nonpregnant uterus is about 5–8 cm long, 3–5 cm wideand 2 cm thick. If it is enlarged and soft, consider pregnancy.• Shape: The body of the uterus should be rounded and pearshaped.If it is irregular, it may indicate the presence of fibroids;if heart-shaped it may indicate a uterine anomaly, such as adouble uterus.• Location: The uterus should be located in the midline. If the top(fundus) is pushed either to the right or left, this suggests possiblescar tissue (adhesions), adnexal (ovarian or fallopian tubal)masses or pregnancy (possibly ectopic).• Consistency: The body should feel smooth and firm. If it isuniformly soft, suspect pregnancy.Cervical Cancer Prevention Guidelines for Low-Resource Settings G-27