Other causes of bleeding in early pregnancy cervical ectropion eversion ) -

wrong to say cervical erosion -this condition appear at ( puberty ) ( pregnancy )

Cause : increase level of estrogen -normal tissue of cervical columnar epithelium cells ,while vaginal tissue is seguammous epithelium

pathology : proliferation of columnar epithelial cells extend from cervical os to vagina Morphology : vagina become red dark appearance

Clinical presentation : -excessive vaginal discharge -tissue become fragile & liable to bleed -intermittent blood stained loss -spontaneous bleeding after sexual intercourse

Diagnosis : By client complain &speculum examination Treatment: no need for treatment ,resolve spontaneously in the pueriperum period

cervical polyps (precancerous condition ) Definition of polyps : small ,vascular ,pedinculated growth Component of polyps : -sequammous -columnar epithelium -connective tissue -blood vessels

Pathology : -hyperplasia of cervical canal & external cervical os -c\p: -asymptomatic -bleeding during pregnancy

Dx: Speculum examination Rx: No treatment during pregnancy ,if sever bleeding ---pap smear ??malignancy

carcinoma of the cervix : -incidence 1\6000 -cancer cervix diagnosed during pregnancy in the 1st &2nd

Types of the cancer cervix: seguammous cell carcinoma Aden carcinoma polyps etiology : infection with HPV human papilloma virus type 16 18 ,this infection persist in the epithelium

clinical picture : -blood stained vaginal discharge Diagnosis: 1-screening pap smear (routine ) 2-speculum examination 3-colopscopy 4-cervical biopsy

Treatment cancer cervix depend on:-on gestational age -stage of the disease 1-cone biopsy : cervical excision -this operation done under GA -it is diagnostic &treatment at the same times

Complication of this procedure : risk of hemorrhage risk for miscarriage if the mother in the 1st and 2nd trimester better for termination of pregnancy to get treatment

c\p: asymptomatic diagnosis: colopscopy -pap smear ( papanicolaou ) smear treatment: after pregnancy ended , follow up by colopscopy to detect the stage of the disease

vaccination against HPV 16,18 was developed given at woman aged up to 26 years old -effective in prevention of development CIN -not safe during pregnancy -this vaccination will not obviate the need for cervical screening

woman age 26 years discuss the benefit of vaccine

Risk group woman to develop HPV learning disabilities minority ethnic group indigenous population sexually active sexually abuse smoker less access to health care