Gynecology Book

http://www.fpnotebook.com/

Colposcopy

Advertisement

  1. See Also
    1. Cervix Anatomy
    2. Colposcopy Findings
    3. Colposcopy Protocol
  2. Indications
    1. See Cervical Dysplasia
    2. Abnormal Pap Smear (ASC-US x2, ASC-H, LSIL, HSIL)
  3. Prepare Patient
    1. Consent
    2. Questions
    3. Ibuprofen 800 mg 30 minutes before procedure
  4. External Exam
    1. Bimanual
      1. Uterus size and pain on palpation
      2. Cervix position
      3. Cervical Motion Tenderness (CMT)
    2. Vulva
      1. Obvious condyloma
      2. Apply Acetic acid after cervical exam
      3. Avoid acetic acid before performing Pap Smear
  5. Cervical Exam (Gross Exam)
    1. Warmed Speculum
    2. Vaginal stint indications
      1. Obese patient
      2. Multiparous patients
    3. Cervical Exam without microscopy
      1. Signs of obvious inflammation
      2. Gonorrhea and Chlamydia testing
      3. Pap Smear
      4. ViraPap (Tests for Human Papilloma Virus 16 and 18)
  6. Cervical Exam (Under Colposcopy)
    1. Apply Acetic Acid (5%) with cotton swab every 5 min
    2. Scan entire cervix at low power (5x)
    3. Observe Vascular patterns at high magnification
      1. Consider use of the green filter
    4. Consider Lugol's Solution to clarify lesion sites
      1. Sharply outlines potential biopsy sites
    5. Mentally Map areas or obtain pictures
    6. Is Colposcopy Adequate?
      1. Is Entire Squamocolumnar Junction (SCJ) visualized?
        1. Consider Kogan endocervical speculum
      2. Any visualized lesions seen in entirety
      3. Endocervical curettage (ECC) is negative
      4. Colposcopy and biopsies agree with Pap Smear
  7. Biopsies
    1. Endocervical Curettage (ECC)
      1. Consider topical benzocaine on swabs
        1. Leave in endocervical canal for 30 seconds
      2. Kevorkian curette rotated 360 degrees twice
      3. Contraindicated in pregnancy
    2. Cervical Punch Biopsy
      1. Obtain 3 mm samples
      2. Start with inferior sites and work upwards
        1. Less blood interference from other biopsy sites
      3. Not necessary to include normal margins in biopsy
      4. Do not use Monsel's until after all biopsies taken
    3. Ectocervical Brush (experimental)
      1. New stiff bristled brush designed for colposcopy
      2. More effective than cervical Punch Biopsy
        1. Brush correlation with loop excision: 76-79%
        2. Punch Biopsy correlation with loop excission: 53%
      3. Significantly less pain than with Punch Biopsy
      4. References
        1. Monk (2002) Obstet Gynecol 100:1276
  8. Coagulation of Bleeding
    1. Monsel's Solution
      1. Should be thickness of toothpaste
      2. Swab out excess Monsel's and Bloody debris
    2. Silver Nitrate
      1. For isolated bleeders
  9. Ending of Procedure
    1. Observe vaginal walls while removing speculum
      1. Use a dental mirror pre-heated in warm water
    2. Patient rests supine for several minutes
    3. Diagram exam
      1. Document cervical os
      2. Document Squamocolumnar junction (SCJ)
      3. Document biopsy sites
  10. Post-Procedure instruction
    1. No intercourse or tampons for 7 days
    2. Return to clinic
      1. Foul vaginal odor or discharge
      2. Pelvic Pain
      3. Fever
    3. Follow-up for histology results in 2 weeks
  11. Additional precautions
    1. Perform LEEP procedure during Follicular Phase
      1. Luteal Phase associated with heavy bleeding
      2. Paraskevaidis (2002) Obstet Gynecol 99:997
    2. LEEP histology has a high false negative rate
      1. Follow all dysplasia closely regardless of histology
      2. Livasy (2004) Obstet Gynecol 104:250
  12. References
    1. Brotzman (1994) J Fam Pract 39:271
    2. Coppleson (1993) Obstet Gynecol Clin North Am 20:83
    3. Ferris (1991) J Fam Pract 33:506
    4. Newkirk (1990) J Fam Pract 31:171

Colposcopy (C0009417)

Definition (MSH)The examination, therapy or surgery of the cervix and vagina by means of a specially designed endoscope introduced vaginally.
Definition (NCI)(kul-PAHS-ko-pee) Examination of the vagina and cervix using a lighted magnifying instrument called a colposcope.
Definition (NCI)Endoscopic examination of the uterine cervix and vagina.
ConceptsDiagnostic Procedure (T060) , Therapeutic or Preventive Procedure (T061)
MSHD003127
EnglishColposcopies, Colposcopy
Spanishcolposcopia
Parent Conceptsendoscopy (C0014245), Diagnostic Radiology Modality (C1547664), Diagnostic Techniques, Obstetrical and Gynecological (C0011913), Gynecologic Surgical Procedures (C0038902), Obstetric Surgical Procedures (C0038906), Gynecological examination (C0200044), Ambiguous concept (C1274012), Colposcopic procedure (C1827815)
SourcesAOD, CSP, HL7V2.5, LCH, LNC, MSH, MTH, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree