Characteristics of vaginal smears in pathological proceeding pregnancy

Before reading we encourage you to read: "The criteria for assessing the state of the vagina"

At complicated pregnancy cytological picture of vaginal smears is not typical for this period of pregnancy or does not match any of the types of strokes, observed during physiological pregnancy. In these cases, especially the great importance the study of vaginal smears in dynamics.

Diagnosis of premature miscarriage

With the threat of termination of pregnancy change the cytological picture of vaginal smears may be related to hormonal disorders (a decrease in the production of progesterone, change concerning the ratio between estrogen and progesterone, as well as decreased production of progesterone and, and estrogen), and they often precede clinical symptoms of threatened abortion, which is very important for timely diagnosis and necessary treatment measures.

With the threat of miscarriage, due to hormonal deficiency, the most commonly observed three types of vaginal smears:

• Estrogenic;
• Atrophic;
• Rehressyvnыy, or dystrofycheskyy.

Estrogenic type of strokes observed with a decrease in the production of progesterone. In this case, the background reduction in the total number of cells increases the amount of surface cells, CI and EI increased to 20 30 % or more in the first trimester and the before 10 % and more in the second and third trimesters of pregnancy. Reduces the percentage of cells navicular. The cells are arranged separately, There are no seams.

Established, that is a bad prognostic sign kolpotsitogramma, when kotoroya indicators CI close to the percentage of superficial cells or equal to.

Atrophic smear type characterized by a predominance of small intermediate cells of the lower layers of the epithelium with large nuclei, the presence of a small amount of parabasal cells (to 1 % and more). Cells are arranged in small groups, There are no seams.

Rehressyvnыy (dystrofycheskyy) type of strokes. Found cells of all layers of the vaginal epithelium, until parabasal. KI can be upgraded. Location cell separation, There are no seams.

With the threat of miscarriage, not due to hormonal deficiency, and any other causative agent, there may be a normal kolpotsito- logical picture.

Diagnosis of fetal status

Violation of the condition of the fetus, regardless of its cause, usually, due to the change in function of the fetoplacental complex and decrease estrogen production. The latter fact as the basis colpocytologic study to assess the condition of the fetus.

In the vaginal smears of pregnant women in this pathology are detected small intermediate cells with darker colored cytoplasm and parabasal. The content navicular cells is reduced or they are completely absent. Location cell separation, beds are not available or are found isolated, loosened.

Reducing the level of sex hormones and their relations are not only quantitative, but also qualitative changes in the cells, which consist in reducing the size and appearance of pathological staining (eosinophilia intermediate and parabasal cells). These changes were observed at a mild fetal hypoxia, than quantitative.

Intrauterine fetal death cytology may be manifested in the form of atrophy of the vaginal epithelium with a predominance of smear couple, bazalnыh cells, and a high degree of proliferation.

Normal vaginal smear cytological picture is not always indicative of a good condition of the fetus, but in most cases kolpotsitogramma while reducing estrogen production reflects the clinical signs of fetal development.

Treatment of vaginal smears of cytolytic and inflammatory types of obstetric pathology is possible only after appropriate treatment.

Perenashivanie pregnancy

True perenashivanie pregnancy followed by fetal hypoxia, kolpotsitogramma so in these cases corresponds to the cytological picture of vaginal smears, characteristic disorders of fetus. When pregnancy perenashivanie smears contain small intermediate cells with darker colored cytoplasm and parabasal cells. Location cell separation, There are no seams.

In some cases, the picture is marked perenashivanie smears type approaching date of delivery. In the future, the study of the dynamics of smears revealed parabasal cells.

Thus, perenashivanie in cases of pregnancy is also very important to study the dynamics of vaginal smears.

Discharge of amniotic fluid

If you suspect a discharge of amniotic fluid leaking liquid is collected in a centrifuge tube and centrifuged. For the differential diagnosis of amniotic fluid in the urine is used microscopic examination of streamed liquid native drugs with the use of dyes.

The elements of amniotic fluid fetal epidermis flakes are vellus hair and fat.

Vellus hair It can be detected in native preparation. To detect fat droplets, which are clearly visible in the native preparation, used Sudan III, while fat droplets painted in orange (utensils must be clean and free of grease). To identify the epidermis flakes used as a colorant 1 % an aqueous solution of eosin.

From sludge centrifuged liquid prepared native preparation for microscopic examination, then cover it with a cover glass and Pasteur pipette gently admitted under the cover glass drop 1 % aqueous eosin, which uniformly stains drug. Next, in the same manner was washed with water preparation. Excess water (as before and dye) suctioned off at the opposite end of the filter paper. Under microscopic examination, on a pink background visible unpainted, well contoured scales of the epidermis of the fetus, often located clusters. The scales do not stain, since they are covered with vernix. Epithelial cells of the vaginal mucosa are painted in bright pink. Scales and fat at an early discharge of amniotic fluid found in 99-100 % cases.