Archive for April, 2013

ch. 18 PAP Test

Posted: April 8, 2013 in Gynocology

The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used to detect potentially pre-cancerous and cancerous processes in the endocervical canal (transformation zone) of the female reproductive system.

Pap test

Pap test

Pap test

Pap test


Types of PAP Test :

  1. Conventional Pap—In a conventional Pap smear, samples are smeared directly onto a microscope slide after collection.
  2. Liquid based cytology—The Pap smear sample is put in a bottle of preservative for transport to the laboratory, where it is then smeared on the slide.

The patient may also be referred for HPV DNA testing, which can serve as an adjunct to Pap testing.

Summary of pap test indications
woman’s characteristic indication rationale
never had sexual contact no test HPV usually transmitted by sexual contact
under age 21, regardless of sexual history no test more harms than benefits
age 20–25 until age 50–60 test every 3–5 years if results normal broad recommendation
over age 65; history of normal tests no further testing recommendation of USPSTFACOG,ACS and ASCP;
had total hysterectomy for non-cancer disease – cervixremoved no further testing harms of screening after hysterectomy outweigh the benefits
had partial hysterectomy – cervix remains continue testing as normal  
has received HPV vaccine continue testing as normal vaccine does not cover all cancer-causing types of HPV
post-operative transgender woman no test the neo-vagina does not contain a cervix and cannot be evaluated with a pap smear



ch. 17 Leopold’s maneuvers

Posted: April 2, 2013 in Gynocology

Maternal abdominal examination of the fetus by Leopold’s maneuvers is a common and systematic way to determine the position of a fetus inside the woman’s uterus.

• The lie is the relationship between the longitudinal axis of fetus and mother: longitudinal, oblique, and transverse.


Presentation is the relationship between the leading fetal part and the pelvic inlet: cephalic, or breech. The presenting part may be the fetal heard or the breech. Ordinarily, the head is flexed sharply so that the chin is in contact with the thorax. In this circumstance, the occipital fortanel is the presenting part, and such a presentation is usually referred to as a vertex or occiput presentation.

Position is the relationship between definite part of the fetus (back) to the right or left side of maternal pelvis. With each presentation there may be two position: right (II-second) or left (I-first). About two thirds of all vertex presentations are in the left occiput position and the one third in the right.

Fetus Back Presentations Examples. Step 1 (Right) Step 2 (Left)

Fetus Back Presentations Examples. Step 1 (Right) Step 2 (Left)

Variety is the relation of the back of fetus to the anterior and or posterior side of the mother’s pelvis. There may be two variety anterior or posterior. 
Engagement – the fetal is engaged if the widest leading part (typically the widest circumference of the head) is negotiating the inlet. 
With the mother lying comfortably on her back, the examiner faces the patient for the first 3 steps, and faces towards her feet for the fourth.


1. FIRST maneuver. Having established the height of the fundus, the fundus itself is gently palpated with the fingers of both hands, in order to discover which pole of the fetus (breech or head) is present. The head feels hard and round, and is easily movable and ballotable. The breech feels soft, triangular and continuous with the body. A professional can also determine the level of the uterine fundal height (but not in cm, on the levels; on the level of umbilicus, ribs, xiphoid process).

2. SECOND maneuver. The palms hands are now placed on the sides of the abdomen. On one side there is the smooth, firm curve of the back of the fetus, and on the other side are fetal extremities (arms, legs) that are felt like small irregularities and protrusions. It is often difficult to feel the fetus well when the patient is obese, when there is a lot of liquor or when the uterus is tight, as in some primigravidas.

3. THIRD maneuver. The examiner grasps the lower portion of the abdomen, just above the symphysis pubis, between the thumb and fingers of one hand. The objective is to feel for the presenting part of the fetus and to decide whether the presenting part is loose above the pelvis or fixed in the pelvis. If the head is loose above the pelvis, it can be easily moved and balloted. The head and breech are differentiated in the same way as in the first step.

4. FOURTH maneuver. The objective of the step is to determine the amount of head palpable above the pelvic brim, if there is a cephalic presentation. The examiner faces the patient’s feet, and with the tips of the middle 3 fingers palpates deeply in the pelvic inlet. In this way the head can usually be readily palpated, unless it is already deeply in the pelvis. The amount of the head palpable above the pelvic brim can also be determined.