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

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

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

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

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

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

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

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

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

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

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

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

13. 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

14. 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

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

16. 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

17. woman age 26 years discuss the benefit of vaccine

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