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in
Womens Health
OFFICE GYNECOLOGY
H. B. Albao, MD. FPOGS
BBT
Maturation Index
Fern test
Spinnbarkheit Test
Serum progesterone or urinary
progesterone metabolites levels
determination
Colposcopy
Ultrasound
Magnetic Resonance Imaging (MRI)
Computed Tonography Scan
Hysteroscopy
Hysterosalpingography
Vaginal pH Test
pH test paper & a color chart
for determining your vaginal
pH:
To perform the test,
hold the pH test paper
against the wall of your
vagina for a few seconds.
compare the color of your
pH test paper to the color
chart.
choose the color your test
result most closely
resembles to the pH
paper.
Vaginal pH
Normal vaginal pH - 3.8 - 4.5 (slightly acidic)
Maintained by lactobacillus, which produce
hydrogen peroxide;
diphtheroids & Staphylococcus epidermidis.
Vaginal pH Test
Conditions
Normal vaginal pH
pH
Bacterial vaginosis
3.8 4.5
> 4.5
4.5
Trichomonas vaginalis
> 4.5
Whiff Test
Drops of a 10% potassium hydroxide
(KOH) solution are added to a sample of
vaginal discharge.
(+) Whiff Test
A FISHY AMINE odor
Suggestive of Bacterial vaginosis (BV)
Hanging Drop
Technique
Drops of a normal saline solution
(NSS) are added to a sample of vaginal
discharge in a SPECIAL glass slide with
a concavity at the center.
Put a cover slip, invert the slide &
examine directly under the microscope
under the 400x objective.
Hanging Drop
Technique
Presence of
motile
protozoans with
undulating
membranes - Trichomonas
vaginalis
KOH Smear
A simple and reliable technique for
diagnosis of vulvovaginal candidiasis
(VVC).
Drops of a 10% potassium hydroxide
(KOH) solution are added to a sample of
vaginal discharge.
Examine in the microscopic under the
100X objective.
KOH Smear
The presence of
hyphae Candida albicans
C. albicans a commensal
agent in 15-20% of
women
Vulvovaginal
candidiasis (VVC)
Clinical Findings
No acetowhite lesions or faint
acetowhite lesions; polyp,
cervicitis, inflammation,
Nabothian cysts.
Test-positive
Suspicious for
cancer
Negative
Photo source: JHPIEGO
Positive
Schillers test:
Visual inspection with Lugols iodine
(VILI),
uses Lugols iodine instead of acetic acid.
Clinical Findings
Squamous epithelium turns
brown and columnar epithelium
does not change color; or
irregular, partial or non-iodine
uptake areas appear.
Test-positive
Suspicious for
cancer
VILI: test-negative
The squamous epithelium
turns brown and columnar
epithelium does not
change color.
VILI: test-positive
Well-defined, bright
yellow iodine nonuptake areas touching
the squamocolumnar
junction (SCJ).
Well-defined, bright
yellow iodine nonuptake areas close to
the os if SCJ is not seen,
or covering the entire
cervix.
Photo source: IARC
Surgery
Radiotherapy
Chemotherapy
Palliative care
Papanicolaou Smear
Screening or Early Detection for
Cancer of the Cervix
Cervical cytology testing
Done by examining a cellular sample
scraped from the uterine cervix and
properly prepared and stained.
Pap Smear
Initial screening should begin
at age 21 or
3 years after the individual becomes sexually
active.
High-risk women, those with a history of early
sexual activity and multiple partners, ANNUALLY.
Those with later exposure to coitus who have only
one sexual partner and who have had three
successive negative annual smears may be
considered low risk and should be screened every
2 to 3 years at the discretion of the physician.
Endometrial biopsy
BBT
Maturation Index
Fern test
Spinnbarkheit Test
Serum progesterone or urinary progesterone
metabolites levels
determination
Endometrial biopsy
One of the diagnostic tests most
frequently performed by gynecologists
on an OPD basis.
A rapid, safe, and inexpensive sampling
of the endometrial lining is a common
procedure in the clinical workup of
women with abnormal vaginal bleeding.
Endometrial biopsy
Indications are:
Ovulation and Dysfunctional uterine
bleeding (DUB)
demonstrate secretory endometrium
Postmenopausal bleeding
To investigate AUB associated with HRT
Chronic uterine infection
Demonstrate the classic giant cell &
tubercules
i.e. TB
Endometrial biopsy
Uses instruments
that aspirate tissue
from the
endometrial lining
following abrasion
or scraping with a
small curette or
perforated cannula.
Office endometrial aspiration
with 3-mm Randall suction
curette.
Endometrial biopsy
Uses cannulas in that
are 2 to 4 mm in
diameter and are
plastic.
Aspiration of the
endometrium is usually
accomplished by a
syringe.
Pipelle endometrial suction curette.
Note small diameter and flexible nature.
Suction is produced by partly withdrawing
inner stem.
Endometrial biopsy
Pipelle cannula
thin, flexible
polypropylene is as
effective as rigid
instruments in obtaining
endometrial specimen
often with less discomfort.
instrument of first choice
for endometrial sampling.
Endometrial biopsy
Contraindications:
Profuse bleeding is a relative
contraindication.
Endometrial biopsy should not be
performed more than 14 to 16 days
after ovulation
because of the possibility of interfering with
an early pregnancy.
Endometrial biopsy
OPD Procedure
It is helpful to explain to
the patient that she will
experience uterine
cramping during the short
time that the biopsy
instrument is inside the
uterus.
A bimanual examination is
performed to note the size
of the uterus and direction
of the uterine cavity.
Endometrial biopsy
A single-toothed
tenaculum used to secure
the anterior cervical lip.
The exocervix is then
cleaned of mucus and
bacteria with an iodine
solution prior to sampling.
In abnormal bleeding
at least four separate areas
should be abraded.
Endometrial biopsy
Cervical stenosis or spasm.
most frequent problem in
performing endometrial
sampling.
Endometrial biopsy
Major advantages of the endometrial
biopsy over D&C are:
convenience and cost savings
The clinical results obtained depend on
two factors:
1. the patient's acceptance
acceptance is higher with narrow cannulas made
of plastic.
Endometrial biopsy
Routine preoperative endometrial
biopsy in asymptomatic women
undergoing hysterectomy:
is an unnecessary procedure
does not improve patient care.