KATIE OSTROM PAPS, ABORTION, AND VACUUM DELIVERY

PAP SMEARS Start age 21 20’s: every 3 years 30’s: every 5 years + HPV screen Hysterectomy or >65: may stop unless history of CIN 2, 3, CIS or vaginal cancer

ABNORMAL PAP RESULTS ASCUS 30’s If High- Risk HPV positive, do colposcopy 20’s If High- Risk HPV positive, do colposcopy

ABNORMAL PAP RESULTS ASCUS and possible high grade HGSIL Colposcopy (or LEEP* if HSIL) *LEEP is Loop Electrical Excisional Procedure. 1 is OK but >1 or a Cold Knife Cone biopsy should have a cervical cerclage with future pregnancies.

PAPS IN PREGNANCY ASCUS: repeat Pap post-partum LSIL: colposcopy in pregnancy or post-partum HSIL: colposcopy. Biopsy OK but no ECC* *Endocervical currettage

ABORTION TYPES Threatened : bleeding + cramping Cervix closed, + FHT, + bleeding Inevitable : bleeding + cramping + cervix dilated Cervix open, +/- FHT, + bleeding Incomplete : cervix open, +/- FHT, + bleeding Missed : cervix closed, - FHT, - bleeding

ABORTION TESTING Blood type and Rh* HCG : going up or down? Progesterone level Low with abnormal placentation High may be OK *Major blood type incompatibilities between A, B, and O produce antibodies, as does Rh (+/- D protein on surface of RBCs). However, antibodies against D interact only with the surface antigens of fetal RBCs, and not all fetal tissue as in A, B, and O antibodies, thus causing much more damage and fetal anemia. RHOGAM is available to treat this.

ABORTION MANAGEMENT Abortion Management Expectant Medical* Surgical** *Mifepristone (anti-progesterone) + Misoprostol (prostaglandin) ** D&C using sonogram guidance and suction with sharp steel curettage at the end.

Place over bone plates, not over the fontenelles Pump to green vacuum level Pull only with uterine contractions 3 Pop-offs are acceptable, then do C- section VACUUM DELIVERY If chin-posterior presentation, do C-section immediately.