Colposcopically directed cervical biopsy and cervical curet-tage is primarily used to investigate abnormal findings on routine pelvic examination or an abnormal Pap smear. Consensus guidelines for the management of cervical intraepi-thelial neoplasia (CIN) have been developed (Wright et al., 2007). Colposcopy requires diligent record keeping and patient communication with follow-up arranged pending pathologic results. Contraindications to colposcopy are current infection and delivery within the preceding 6 weeks. Pregnancy does not preclude colposcopy but may impact the decision to biopsy the cervix or perform endocervi-cal curettage based on increased bleeding and miscarriage risks. A pregnancy test is best performed before a biopsy is contemplated. Patients should receive informed consent and understand the risk and benefits as well as their responsibility to follow up based on exam findings.

Colposcopy is performed with a stereoscopic operating microscope with correct focal length. The patient is placed in the dorsal lithotomy position. The vulva and introitus are inspected for lesions. A speculum is placed in the vagina, with the size selected to maximize visualization of the cervix and minimize patient discomfort. The vaginal canal and cervix are visualized and any abnormal lesions of concern noted. Acetic acid (3%-5%) is applied to the vaginal canal and cervix liberally with a cotton swab. Abnormal areas will display as acetowhite or leukoplakia with the acetic acid and may also show signs of punctation, mosaicism, or frank abnormal changes of superficial vessels. A green light filter can assist with visualizing atypical vascular changes. Lugol's solution can also be applied to improve identification of abnormal tissue, taken up by glycogen in normal mature squamous cells and not by dysplastic, metaplastic, or columnar epithelial tissues. Any findings are recorded in a drawing to correlate with biopsy sites or abnormal pathology. Satisfactory examination includes full visualization of the entire transformation zone between squamous and columnar epithelium at the cervical os. Most pathology is located in this zone. An endocervical speculum can be used to assist in visualization. Types of future treatment for any lesion seen should be considered and noted for ease in planning future management.

Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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