The internal exam is done only at the delivery under strict asepsis with a double set-up -painless vaginal bleeding during the third trimester maybe a sign of placenta praevia. if internal examination is done in this kind of condition, this can lead to even more bleeding and may require immediate delivery of the baby by cesarean section. if the bleeding is due to soft tissue injury in the birth canal, immediate vaginal delivery may still be possible so the set up for vaginal delivery will be used. a double set-up means there is a set up for cesarean section and a set-up for vaginal delivery to accommodate immediately the necessary type of delivery needed. in both cases, strict asepsis must be observed.
