The Cervix SN Tripathy
INDEX
Page numbers followed by f refer to figure, and t refer to table
A
Abdomen, lower 117
Acetic acid 134, 142, 168
role of 142
Acetowhite epithelium 138, 139f, 143f, 144f, 147
Acquired ectopy 113
Adenocarcinoma 170
in situ 145, 148, 170
Amenorrhea 120
American College of Obstetricians and Gynecologists 9, 29, 36, 53, 54, 75, 128
American Society for Colposcopy and
Cervical Pathology 96
Androgens 35
Anteflexion 16
angle of 17f
Anteversion 16
angle of 17f
Anti-Müllerian hormone 13
Arbor vitae 16, 17f
Arias-Stella phenomena 96
Assisted reproduction technology 13
B
Balloon devices 37
Basal layer 136
Binocular colposcope 134f
Biopsies 98, 145
Bishop scoring system, modified 7t
Bleeding per vagina 117
Blood vessels 29
C
Cancer 145f
cervix 8, 10, 95, 153
glandular cells 8
Human papillomavirus-associated 172f
signs of 158
squamous cells 128
symptoms of 158
Canine visceral leishmaniasis 82
Carcinoma
cervix 153
invasive 100, 103, 134
Cells, epithelial 26
Cerclage 57
operations 60
stitches 67
techniques 60
Cervical
agenesis 13
anatomy 72, 135
architecture 84
barrier method 73
biomechanics 46
canal 50f
cancer 8, 97, 117, 127, 128, 133, 134, 153, 164, 166, 168
management of 95
screening recommendations 129t
treatment of 102
caps 73, 74
carcinoma 8
colposcopy 148f
consistency index 51
cycle 26
cysts 118
defects 58
dilatation 23, 62
phases of 48
dystocia 62
ectopic pregnancy 69f
ectopy 73, 75, 113, 113f
ectropion 118, 118f
endometriosis 116
epithelium 19,49,50
erosion 113f
fibroid 117, 117f, 118
glands 66, 78
hyaluron synthase 37
hydration 46
infection, persistent 134
insufficiency 6, 53, 54, 55f, 59
intraepithelial neoplasia 71, 72, 80, 96, 111, 127-129, 131, 134, 140f, 167-169, 172
laceration 62
length 9
ligament, transverse 17
maturation 28, 29
mucus 21,28,71,77, 78f, 79, 81
fern test 46f
plug 28,29
myomas 117
pessary 56
physiology 72
polyp 115, 115f, 116f
pregnancy 65, 66
remodeling 44, 85,86, 88f, 90t, 91
rings 15
ripening 46
physiology of 29
techniques 33
signs 44
softening 22
stenosis 12, 15, 116, 117f
stroma 87f
stromal cells 29
tissue 35, 46
trauma 53
tuberculosis 119, 120t, 121t
Cervicitis 72, 114, 114f
infectious 114
noninfectious 114
Cervicovaginal fluid 56
Cervix 3-5, 6f, 7, 17f, 18, 21f-24f, 26, 43, 44f, 48, 48f, 66, 71, 73, 74, 113f, 129f, 134, 134f
abnormal 133
acquired diseases of 113
adenocarcinomas of 33
anatomy of 112f, 135, 135f
aspects of 3
benign diseases of 111
composition of 6
congenital
absence of 112
anomalies of 112
elongation of 112f
functions of 43
funneling of 55f
healed 122f
healthy 134
hypoplasia of 112
imaging of 8, 49
inflammation of 72
invasive carcinoma of 71,72
length of 19f
ligament support of 17f
menopausal 137f
molecular biology of 84
normal 113f, 133
pathology of 72
physiology of 26
sparing hysterectomy 7
strawberry 115f, 138
supravaginal part of 112
surgical anatomy of 12
tuberculosis of 8
ultrasonography of 8
visual inspection of 134
Chadwick's sign 44
Chlamydia trachomatis 114,165
Chlamydial cervicitis 115f
Chorioamnionitis 59
Chorionic villi 69f
Collagen 85
Colposcope check report 147f
Colposcopy 98,133,148
advantages of 148
basic instruments of 140, 141f
basis of 135
contraindications of 135
indications of 134
limitations of 148
steps of 140
transformation zone 144f
Columnar epithelium 135, 136, 137f, 148
Oral contraceptive pills, combined 74
Cone biopsy 98
Contraception 71, 73, 74
hormonal 73
long-acting reversible 71
Contraceptive
adverse effects of 74t
counselling, protocol for 75
method, types of 73
Cryosurgery 114
Cryptomenorrhea 15
Cusco's speculum 140
Cysts 21
Cytokine 81
D
Dehydroepiandrosterone sulfate 35
Dendritic cells 172
Depot medroxy-progesterone acetate 73, 74
Diathermy cauterization 114
Didelphic uterus 15, 16f
Diethylstilbestrol 12, 15,33, 54, 112
Dinoprostone 36
Double cervix 14,72,75
Dyspareunia 115, 159
Dysuria 115
E
Ectopy 72
congenital 113
Ehlers-Danlos syndrome 53, 54
Electron microscopy 19
Endocervical
canal 20f, 135, 136
curettage 145
epithelium 50
glands 20f, 21
speculum 141, 146f, 147f
Endocervix 21f, 65, 137f
Endometriosis 116
Endoplasmic reticulum 85
Enzyme hyaluronidase 89
Epithelia 87f
Epithelioid histiocytes 121f
Epithelium 87
Estrogen 34, 46
receptor 30
Ethambutol 121
Exocervix 15
Extracellular matrix 3,6, 10,29, 43, 84
F
Fallopian tubes 8
Fascia around cervix 17
Female pelvis
lymphatic drainage of 23f
vessels of 23f
Female reproductive
system, autonomic innervations of 24f
tract 14f
Fern patterns 27f
Fertility 103
Fetal
fibronectin 56
membrane
properties 46
stripping of 48
Fluorodeoxyglucose positron emission tomography 99
Foley's catheter 37
Folic acid antagonist 67
Fothergill's operation 17
Foul smelling vaginal discharge 120
Friedman's curve 48f
Fusion anomalies 112
G
Gartner's duct cysts 118
Gestational sac 66
Gland openings 148
Glandular cells 127
atypical 145, 148
Glycosaminoglycan 89
Gonadotropin-releasing hormone 33
Goodell's sign 44
Granulocyte colony stimulating factor 30
Granulomas containing Langerhans’ giant cells 121f
H
Halban technique 18
Healed transformation zone 141f
Hegar's sign 44
Hegar's dilator, passage of 56
Hematometra 15
Hemorrhage 62
antepartum 114
severe 59
High-grade squamous intraepithelial
lesion 96, 128, 145, 148
Hormone 85
metabolism 89
Human immunodeficiency virus 169
infection 8, 132
Human papillomavirus 8, 127, 134, 164, 166-168, 172, 173
genotypes 166
infection 8, 122, 131f, 134, 165, 165f
natural history 165
testing 131, 167
vaccine 164, 169
Human uterine cervix 6
Hyaluronan
functions 88f
role of 89
Hyaluronic acid 30, 46
Hyaluronidase 37
synthases 87f
Hydroxyeicosatetraenoic acid 30
Hygroscopic dilators 37
Hypertrophic columnar epithelium 142
Hysterectomy 7, 67
radical 157
sub-total 7
Hysterocervicography, premenstrual 56
Hysterosalpingography 8
I
Iliac fossae 5
Immune cells 90
role of 85, 89
In vitro fertilization 81
Infertility 120
Inflammation 90
Insler score 21
modified 15t
Interconceptional period 56
Internal iliac vessels 67
International Agency for Research on Cancer 33, 74
International Federation of Cervical Pathology and Colposcopy 148
International Federation of Gynecology and Obstetrics 96
Intracorporeal surgeon's knot 58f
Intracytoplasmic sperm injection 82
Intrauterine
contraceptive devices 74
infection 62
insemination 81
Invasive cervical cancer 8, 170
Ipsilateral renal anomaly syndrome 15
Ischial tuberosity 5
Isoniazid 121
J
Junctional proteins 89
K
Kegel exercises 160
Khanna's sling operation 18
Killer cells, cytokine-induced 172
L
Labor, stages of 47f
Ladin's sign 44
Laminaria japonica 7,37
Langhans’ giant cells 122
Laparoscopic cerclage 58
placement 59
Laparoscopy 15f
Laparotomy 67
Lea's shield 73
Leukoplakia 142f, 148
Levonorgestrel 73
Lipopolysaccharide 91
Liquor amnii 50f
Loop electrosurgical excision procedure 80, 134f, 147, 168, 169
Lower uterine
endometrium 69f
segment 46, 59
Low-grade
intraepithelial lesions 166
squamous intraepithelial lesion 128, 145, 148
Lugol's iodine 134, 136, 145, 145, 146f
application of 136f
Lymphatic drainage 22
M
Mackenrodt's ligament 17
Macrophage
colony stimulating factor 82
inflammatory protein 81
Magnetic resonance imaging 27, 56, 98
Malignant cells 134
Manchester operation 17
Maschowitz technique 18
Matrix metalloproteinases 30, 47,84
Mayer -Rokitansky-Kuster-Hauser
syndrome 12, 13, 15f
McCall culdoplasty 18
McDonald approach 60, 61
McDonald cerclage 60
McDonald cervical cerclage procedure 61f
McDonald techniques 60
Membranes, premature rupture of 62
Menometrorrhagia 120
Menstrual cycle 27
Mersilene tape suture, erosion of 59
Metaplastic epithelium 136
reproductive age 137f
Methotrexate 67
Microinvasive carcinoma 100
Microphthalmia associated transcription
factor 45
Microscopy 18
Misoprostol 36
Mosaic epithelium 140f
Mucinous retention cysts 21
Mucins 79
Müllerian development 13
Müllierian duct 13, 13f, 14, 112
Mullerian hypoplasia 15
Müllierian malformation 13-15
Müllierian structure 13
Myometrial contractions 50
N
Nabothian cysts 5, 21, 131f, 138f, 148
Nabothian follicle 5, 21
N-acetylneuraminic acid 79
Nasal
forceps 141
speculum 146f
National Cervical Cancer Coalition 127
National Comprehensive Cancer Network 131
Natural contraception, Billing's method 73
Neisseria gonorrhoeae 114
Neoadjuvant chemotherapy 95, 101, 104
O
Oral contraceptive pills 32
Organogenesis 95
Ovulatory disorders 33
P
Pain, abdominal 120
Papanicolaou smear 74, 75, 97, 120, 128, 134
Papillomatosis 172f
Paracervical node 22
Pelvic
computed tomography 99
examination 97
lymph node assessment 98
pain 115
Periodic acid-Schiff 19
Pink squamocolumnar epithelium 136f
Policresulen 114
Polyp 142f
Polypoidal endometrium 142
Portio vaginalis 15, 135
Post-coital bleeding 115, 120
Post-coital test 80
Post-menopausal bleeding 120
Pouch of Douglas 5,18
Preinvasive disease 96
Preterm premature rupture of membranes 53, 56, 59
Prevotella intermedia 35
Progesterone 34, 46
only pill 73,74
only preparations 73
Prostaglandin 30, 33, 35
inhibitor 30
Proteins, noncollagenous 85
Proteoglycans 6
Pubocervical ligament 17
Puerperal pyrexia 62
Purandare's operation 18
Pyrizinamide 121
Q
Quasi-static elastography 51
R
Radiation 117
therapy 158
Radiotherapy 156
Rapid mechanical cervical dilation 53
Rectum 15f
Reddish columnar epithelium 136f
Renal unilateral agenesis’ 16f
Rifampicin 121
Royal College of Obstetricians and Gynaecologists 9, 57
Rubin's criteria for histological diagnosis of cervical pregnancy 66
S
Sacral nodes 23f
Secretory leukocyte protease inhibitor 28
Sepsis 62
Sexually transmitted infections 71
Shirodkar dissected uterosacral ligaments 17
Shirodkar's cervical cerclage procedure 61f
Shirodkar's sling operation 18
Shirodkar's technique of transvaginal cerclage 60
Sliding sign 66
Society for Maternal Fetal Medicine 9
Sperm 78
glycocalyx 79
Spermatozoa 21, 78
Spermicides 74
Spiritual crisis 10
Spontaneous preterm birth 9
Squamocolumnar junction 15, 20f, 72, 130, 139f, 141f
Squamous cell 127
carcinoma 128, 170
Squamous epithelium 135, 136, 148
Squamous metaplasia 147
Strawberry trichomonas infection 138f
Streptomycin 121
Sturmdorf suture 113
Subcolumnar reserve cells 72
T
Thromboembolism 59
Transabdominal cerclage 57
Transformation zone 19
large loop excision of 80
normal 136
Transvaginal ultrasound 9, 55
Traumatic epithelial lesions 50
True pelvis 4
Tuberculosis, global burden of 119
Tuberculous lesion
Schirous type of 121f
ulcerative type of 120f
Tumor markers 99
Two-day method 73
U
Upsuck theory 22
Urinary tract infection 117
Uterine
activity 45f
artery 22f
embolization 67
bleeding 66
cervix 12
transformation zone of 20f
fundus, endometrium of 69f
procidentia, reduction of 4f
vessel
bleeding 59
ligation of 67
Uterosacral ligament 17, 18, 23f
Uterus 6f, 17f, 66
anteflexion of 19f
embryology of 14f
ligament support of 17f
lower part of 17f
nature of 4
V
Vaccines, types of 170
Vagina 134
adenocarcinomas of 33
part of 17f
Vaginal
aplasia 13
bleeding 62
delivery 50
diaphragm 73,74
discharge 115
ecosystem 78
infection, persistent 134
pessaries 4
progesterone 9
sponge 73
Valethamate bromide 37
Vessels 138
atypical 147, 148
normal arborization of 138f
Video colposcope 134f
Vulva 134
W
Warts, human papillomavirus-associated 172f
Wolffian duct 13f
Z
Zygote intrafallopian transfer 13
×
Chapter Notes

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THE CERVIX
THE CERVIX
Editor SN Tripathy MD FICOG Ex-Professor and Head Department of Obstetrics and Gynecology Shriram Chandra Bhanj (SCB) Medical College, Cuttack Odisha, India
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The Cervix
First Edition: 2018
9789352702091
Printed at: Sanat Printers
My husband, Prof Satchidananda Tripathy
My Guru and Marg Darshak
Contributors Preface
I always wonder about the Cervix, how an organ can function so diametrically oppositely in pregnancy and later in life, becomes the woo of millions of women. Cervix fascinated me from the very beginning of my carrier and still I go on wondering about it. It is the most mystic organ of the body, and I tell it, ‘The Mystic Cervix.’
Whatever and whenever we desired a function from it, it complies. For example, in pregnancy, we want that the organ should remain closed, it remains so, as soon as labour starts we want, it should dilate as quickly as possible and we desire that it should forego its identity, it does so, it completely dilates and merges with the uterus. We want that it should come back to its former form in puerpureim, it comes back to its original state. Gone are the days when only we relied on Bishops score to know the same. On the other hand we expect it should not allow any organisms to pass through it, but allow only the sperm so that it can fertilize the ovum. Strangely it complies to this wish too. What a strange organ !!!. Remodeling of the cervix has gone a sea change due to advancement of molecular biology of the cervix. Similarly our understanding of cancer cervix has made a somersault. For the last so many decades, we are proving that it is an infective condition caused by a sexually transmitted virus, the HPV virus. What baffled me while editing the book is that I was ignorant about so many aspects of cervix. The molecular biology of cervix during pregnancy and labour is progressing in a tremendous rate. We are rewriting cancer cervix. First it was known that it is an infective viral disease, then the preventing vaccines are coming one by one. Now there are so many therapeutic vaccines in several phases of trials to treat the disease along with surgery, radiotherapy and chemotherapy. It is difficult to keep pace with the developments. I have tried my best to incorporate all the advancement in the cervix to a certain point of time. Please bear with me if there is some lacunae somewhere.
This text spans everything from embryology to the emotional trauma women undergo when their cervix is removed at hysterectomy. Essential for gynecologists, oncologists, basic scientists, GPs, nurses, colposcopy practitioners. This is the only definitive major clinical reference book published on the cervix.
I hope and believe that like our previous books, The Uterus, The Fallopian Tubes, Tuberculosis Manual for Obstreticians and Gynaecologists, this book will be liked by all of you, whatever you wanted to know is under one cover. Happy reading !
SN Tripathy
Acknowledgments
‘When you steal from one author, it is plagiarism, if you steal from many it is research.’ Time and time again we have drawn inspiration from the workers of the bygone era, and umpteen times we have utilized the work of various research workers. We are grateful to all of them.
I am very grateful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Ms Ritu Sharma (Director-Contents Strategy), Ms Chetna Malhotra (Associate Director-Contents Strategy), Ms Sunita Katla (PA to Group Chairman and Publishing Manager), Mr KK Raman (Production Manager) and the whole team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their excellent professionalism, and presentation of the book. I am also thankful to my daughters Susandhya and Susnigdha, son–in-law Abhisek and brother Srikrishna, for their constant help and tolerance, the time I spent, is their time.