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Paps , abortion, and vacuum delivery

This article provides essential insights into cervical health, discussing the recommended age for Pap smears, frequency based on age, and protocols for women over 65. It covers abnormal Pap results and the implications for future pregnancies, including the LEEP and Cold Knife Cone biopsies. Additionally, the document explains various abortion types, symptoms, and management strategies using medications like Mifepristone and Misoprostol. Lastly, it addresses vacuum delivery procedures and critical considerations for managing chin-posterior presentations.

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Paps , abortion, and vacuum delivery

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  1. Paps, abortion,and vacuum delivery Katie ostrom

  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

  4. Abnormal pap results *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 *Endocervicalcurrettage

  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 *Mifepristone (anti-progesterone) + Misoprostol (prostaglandin) ** D&C using sonogram guidance and suction with sharp steel curettage at the end.

  9. Vacuum delivery If chin-posterior presentation, do C-section immediately.

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