1. KATIE OSTROM PAPS, ABORTION, AND VACUUM DELIVERY

2. 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

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

4. 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.

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

6. 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

7. 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.

8. 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.

9. 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.