When recognizing obstetric pathology these tests are used to a limited extent. They are used as additional auxiliary methods for the diagnosis of certain types of obstetric pathology.

Colpocytological research method upon recognition of obstetric pathology did not receive widespread due to insufficient reliability of the results and limited number pathological processes, in which its use can provide some information. Colpo results published cytological studies when diagnosing the threat of spontaneous miscarriage, post-term pregnancy and certain diseases. The authors acknowledge the supporting diagnostic value the data they received. It should be noted that in the presence of signs of colpitis, the results of cytological studies are unreliable, therefore the use this method irrational.

When assessing the results of a colpocytological study, it is necessary to take into account some features inherent in normal pregnancy. Due to hormonal influences During pregnancy (,), thickening of the epithelial cover of the vagina occurs due to some hypertrophy of the parabasal and more significant proliferation of the intermediate layer of the epithelium.

In the first trimester of pregnancy, intermediate and superficial cells predominate in the smear, scaphoid cells are single, the karyopyknotic index (KPI) ranges from 0 to 10-15%. As pregnancy progresses, the cytological picture of the smear changes, characterized mainly by the predominance of intermediate and scaphoid cells; there are few superficial cells, LPI 0-10%. In the third trimester, scaphoid and intermediate cells predominate, the CPI is close to zero. At the end of pregnancy, scaphoid cells disappear, intermediate and superficial cells predominate, the CPI is 15-20% and higher.

When there is a threat of spontaneous miscarriage, the number of scaphoid cells decreases, the number of superficial cells increases, the CPI is 20-30% and higher. This is due to a deficiency of progesterone and estriol. Some authors believe that when the CPI is above 10%, it is necessary to start hormone therapy. With a CPI of 40-50%, pregnancy cannot be maintained.

These changes occur when there is a threat of miscarriage associated with hormonal deficiency. In case of miscarriages of another etiology (for example, due to isthmic-cervical insufficiency), the pregnancy can be terminated with a normal colpocytological picture.

In this case, intermediate and single superficial cells are found in smears. There are also parabasal and basal cells, a lot of mucus and leukocytes.

Measurement basal temperature has an auxiliary value for early diagnosis threats of spontaneous abortion. With the normal development of pregnancy, during the first 4 months there is an increase in basal temperature followed by a decrease. Some authors who observed these changes associate the decrease in basal temperature after 4 months with an increase in the formation of ACTH and glucocorticoids. A persistent decrease in basal temperature in the first 3 months of pregnancy (below 37°C) is a sign of a threat of termination. However, the absence of a decrease in basal temperature during this period does not allow us to confidently predict normal development pregnancy.

Crystallization phenomenon The secretion of the glands of the mucous membrane of the cervical canal can be used as an additional test in recognizing the threat of miscarriage. Signs of a threatening miscarriage are the gaping of the external opening of the cervical canal and the presence of clear mucus with crystallization phenomena.

During normal pregnancy, the external os is closed, mucous secretion is not secreted (“dry neck”), and the phenomenon of crystallization is absent.

Cytological examination of hormonal levels (if there is a threat of miscarriage, cycle disorders). Rules for taking a smear for colpocytological examination

Karyopyknotic index

Karyopyknotic index– colpocytological indicator reflecting percentage the number of exfoliated mature cells to the rest in the vaginal smear. The results allow us to judge the estrogen saturation of the body. CPI is determined as part of a cytological study hormonal levels. The results are used to assess ovarian function, diagnose infertility, threatened miscarriage, menstrual irregularities, hormonal changes during menopause. For the study, material from a urogenital smear is used. The indicators are determined using the cytological method. Normal values depend on the phase monthly cycle: 7-10 days – 20-25%, 14 days – 60-85%, 25-28 days – 30%. Preparation of results takes 1 business day.

Colpocytology – complex laboratory tests aimed at studying rejected epithelial cells vagina, changes in their composition and ratio in different periods cycle. The karyopyknotic index is one of the studied indicators. It is based on the phenomenon of karyopyknosis - the process of maturation of epithelial cells, expressed by a decrease in cell nuclei and wrinkling of membranes. Pyknotic cells have nuclei less than 6 µm in diameter. RPI – the ratio of the number of cells with pyknotic nuclei to the number of cells with non-pyknotic nuclei. The indicator is expressed as a percentage and correlates with the concentration of estrogen.

Indications

The karyopyknotic index reflects estrogen saturation and ovarian functionality. Used to determine the day of ovulation and assess hormonal levels during reproductive age. Within the framework of colpocytology, the test is indicated in the following situations:

Menstrual irregularities. The definition of CPI is prescribed for amenorrhea, opsomenorrhea, oligomenorrhea, dysfunctional uterine bleeding. The result identifies changes in estrogen synthesis as the cause of cycle instability.
Infertility. The test is carried out for the purpose of confirmation/refutation hormonal reasons infertility, ovulation determination.
Complicated pregnancy. The study is used to monitor the pregnancy process in women at risk ( endocrine pathologies, miscarriages and premature birth history), reveals the threat of spontaneous abortion.
Menopausal syndrome. Fading reproductive function accompanied by a decrease in estrogen levels, manifested by hot flashes, sweating, headaches, rapid heartbeat, and emotional instability. The analysis is performed to diagnose the syndrome.
Pathologies of sexual development in girls. The test is prescribed to assess the function of the ovaries and adrenal glands in case of prematurity or delayed puberty, manifested by early onset/absence of menstruation, small size of the uterus, and mammary glands.
Hormone therapy. The study is performed to monitor treatment with estrogen drugs, determine the dosage, and the duration of the course of therapy.

Preparing for analysis

The material for the study is a smear taken from the anterolateral surface of the vagina. Preparation for the procedure consists of a number of rules:

A week before the test, you should consult your doctor about the need to temporarily discontinue medications - hormonal drugs, antibiotics.
Two days before the procedure, sexual intercourse and the use of vaginal suppositories, douching, drinking alcohol, spicy food.
During the last hour you should refrain from urinating.
It is important to tell your doctor the exact date started menstrual bleeding. At inflammatory diseases vagina, uterine bleeding analysis is not carried out - a large number of leukocytes, endometrial fragments reduces the accuracy of diagnosis.

A smear is taken by scraping the vaginal wall with an applicator or spatula. Biomaterial is being processed special drugs, more intensely staining the pyknotic nuclei. Using a microscope, the number of pyknotic and non-pyknotic cells is counted and the percentage is determined.

Normal values

Test data is expressed as a percentage. Norms of karyopyknotic index with undisturbed acid-base balance determined by the phase of the menstrual cycle:

Follicular (after bleeding, 7-10 days of the cycle) – 20-25%.
Ovulatory (12-15 days) – 60-85%.
The end of the luteal phase (25-28 days) – 30-35%.

During pregnancy, the reference values of the analysis are different. They depend on the period:

I trimester – 0-18%.
II trimester – 0-10%.
III trimester – 0-3%.
Before childbirth – 15-40%.

During menopause and postmenopause, CPI values range from 0 to 80%. Their interpretation is made taking into account other colpocytology tests.

Increasing value

The CPI increases with an excess of estrogen - hyperestrogenemia. The violation indicates a number of pathologies:

Endocrine diseases. Estrogen saturation increases with polycystic ovary syndrome, hormone-secreting tumors and ovarian cysts, hyperthecosis, pathologies of the adrenal glands, autoimmune thyroiditis, hypothyroidism, CTH-producing tumors of various locations.
Risk of spontaneous abortion. During pregnancy, an increase in test values reveals the threat of miscarriage or premature birth.
Premature puberty . The karyopyknotic index increases with excessive activity of the adrenal glands and ovaries; in girls under 8-10 years of age, it confirms accelerated puberty.
Obesity. Adipose tissue contains an enzyme that converts androgens into estrogens.
Diseases of the gastrointestinal tract. Level estrogen hormones increases due to disruption of their binding and excretion.
Taking medications. Hyperestrogenemia develops while taking hormonal, anti-tuberculosis and hypoglycemic drugs, barbiturates, and antidepressants.

Decrease in indicator

A decrease in CPI reveals estrogen deficiency - hypoestrogenemia. A downward deviation of the result is determined in a number of cases:

Inflammatory diseases of the genital organs. Among women reproductive age a decrease in estrogen manifests itself in chronic severe colpitis and vaginitis.
Menstrual cycle disorders. Irregular bleeding, scanty discharge, spotting, premenstrual syndrome expressed.
Delayed puberty. Low CPI in girls 16 years of age and older reveals hypofunction of the ovaries, accompanied by the absence or weak expression of secondary sexual characteristics, late offensive menarche.
Pathologies of the pituitary gland. Violation of estrogen synthesis is determined by pituitary dwarfism, cerebral-pituitary cachexia, necrosis of the anterior pituitary gland.
Reception medicines . Estrogen deficiency can develop due to improper use of hormonal drugs, antidepressants, and nootropics.

Treatment of abnormalities

Karyopyknotic index is an indicator of estrogen saturation. The test allows you to detect an excess or deficiency of female sex hormones and is used for diagnosis reproductive health women monitoring pregnancy. The gynecologist and endocrinologist are responsible for interpreting the results and prescribing therapy.

Karyopyknotic index– colpocytological indicator, reflecting the percentage ratio of the number of exfoliated mature cells to the rest in a vaginal smear. The results allow us to judge the estrogen saturation of the body. CPI is determined as part of a cytological study of hormonal levels. The results are used to assess ovarian function, diagnose infertility, threatened miscarriage, menstrual irregularities, and hormonal changes during menopause. For the study, material from a urogenital smear is used. The indicators are determined using the cytological method. The normal values depend on the phase of the monthly cycle: 7-10 days - 20-25%, 14 days - 60-85%, 25-28 days - 30%. Preparation of results takes 1 business day. In total, 16 addresses were found in Moscow where this analysis could be done.

Colpocytology is a set of laboratory tests aimed at studying rejected vaginal epithelial cells, changing their composition and ratio at different periods of the cycle. The karyopyknotic index is one of the studied indicators. It is based on the phenomenon of karyopyknosis - the process of maturation of epithelial cells, expressed by a decrease in cell nuclei and wrinkling of membranes. Pyknotic cells have nuclei less than 6 µm in diameter. RPI – the ratio of the number of cells with pyknotic nuclei to the number of cells with non-pyknotic nuclei. The indicator is expressed as a percentage and correlates with the concentration of estrogen.

Indications

Menstrual irregularities. The definition of CPI is prescribed for amenorrhea, opsomenorrhea, oligomenorrhea, dysfunctional uterine bleeding. The result identifies changes in estrogen synthesis as the cause of cycle instability.
Infertility. The test is carried out to confirm/refute hormonal causes of infertility and determine ovulation.
Complicated pregnancy. The study is used to monitor the pregnancy process in women at risk (endocrine pathologies, miscarriages and premature births in history), and identifies the threat of spontaneous abortion.
Menopausal syndrome. The decline of reproductive function is accompanied by a decrease in estrogen levels, manifested by hot flashes, sweating, headaches, rapid heartbeat, and emotional instability. The analysis is performed to diagnose the syndrome.
Pathologies of sexual development in girls. The test is prescribed to assess the function of the ovaries and adrenal glands in case of prematurity or delayed puberty, manifested by early onset/absence of menstruation, small size of the uterus, and mammary glands.
Hormone therapy. The study is performed to monitor treatment with estrogen drugs, determine the dosage, and the duration of the course of therapy.

Preparing for analysis

The material for the study is a smear taken from the anterolateral surface of the vagina. Preparation for the procedure consists of a number of rules:

A week before the study, you should consult with your doctor about the need to temporarily discontinue medications - hormonal drugs, antibiotics.
Two days before the procedure, you should exclude sexual intercourse, the use of vaginal suppositories, douching, alcohol intake, and spicy food.
During the last hour you should refrain from urinating.
It is important to tell your doctor the exact date when your menstrual bleeding started. In case of inflammatory diseases of the vagina, uterine bleeding, analysis is not performed - a large number of leukocytes and endometrial fragments reduces the accuracy of diagnosis.

A smear is taken by scraping the vaginal wall with an applicator or spatula. The biomaterial is treated with special preparations that stain the pyknotic nuclei more intensely. Using a microscope, the number of pyknotic and non-pyknotic cells is counted and the percentage is determined.

Normal values

Test data is expressed as a percentage. The norms of the karyopyknotic index with an undisturbed acid-base balance are determined by the phase of the menstrual cycle:

Follicular (after bleeding, 7-10 days of the cycle) – 20-25%.
Ovulatory (12-15 days) – 60-85%.
The end of the luteal phase (25-28 days) – 30-35%.

During pregnancy, the reference values of the analysis are different. They depend on the period:

I trimester – 0-18%.
II trimester – 0-10%.
III trimester – 0-3%.
Before childbirth – 15-40%.

During menopause and postmenopause, CPI values range from 0 to 80%. Their interpretation is made taking into account other colpocytology tests.

Increasing value

The CPI increases with an excess of estrogen - hyperestrogenemia. The violation indicates a number of pathologies:

Endocrine diseases. Estrogen saturation increases with polycystic ovary syndrome, hormone-secreting tumors and ovarian cysts, hyperthecosis, pathologies of the adrenal glands, autoimmune thyroiditis, hypothyroidism, CTG-producing tumors of various locations.
Risk of spontaneous abortion. During pregnancy, an increase in test values reveals the threat of miscarriage or premature birth.
Precocious puberty. The karyopyknotic index increases with excessive activity of the adrenal glands and ovaries; in girls under 8-10 years of age, it confirms accelerated puberty.
Obesity. Adipose tissue contains an enzyme that converts androgens into estrogens.
Diseases of the gastrointestinal tract. The level of estrogen hormones increases due to disruption of their binding and excretion.
Taking medications. Hyperestrogenemia develops while taking hormonal, anti-tuberculosis and hypoglycemic drugs, barbiturates, and antidepressants.

Decrease in indicator

A decrease in CPI reveals estrogen deficiency - hypoestrogenemia. A downward deviation of the result is determined in a number of cases:

Inflammatory diseases of the genital organs. In women of reproductive age, a decrease in estrogen is manifested by chronic severe colpitis and vaginitis.
Menstrual cycle disorders. Irregular bleeding, scanty discharge, spotting, severe premenstrual syndrome.
Delayed puberty. Low CPI in girls 16 years of age and older reveals ovarian hypofunction and is accompanied by the absence or weak expression of secondary sexual characteristics and late onset of menarche.
Pathologies of the pituitary gland. Violation of estrogen synthesis is determined by pituitary dwarfism, cerebral-pituitary cachexia, necrosis of the anterior pituitary gland.
Taking medications. Estrogen deficiency can develop due to improper use of hormonal drugs, antidepressants, and nootropics.

Treatment of abnormalities

Karyopyknotic index is an indicator of estrogen saturation. The test allows you to detect an excess or deficiency of female sex hormones and is used to diagnose a woman’s reproductive health and monitor pregnancy. The gynecologist and endocrinologist are responsible for interpreting the results and prescribing therapy.

In 1938 Geist and Salmon proposed to evaluate the cytological picture of a vaginal smear according to four reactions, depending on the degree of estrogenic influences in the body.
First reaction corresponds to severe estrogen deficiency, when only atrophic cells and leukocytes are detected in the smear, the second reaction corresponds to moderate estrogen deficiency, atrophic cells of the basal layer predominate in the smear, cells are found in small numbers intermediate type and leukocytes. With moderate activity of estrogenic hormones, the third reaction is diagnosed. The smear consists of intermediate type cells various shapes and size, individual cell clusters are found.

Fourth vaginal smear reaction detected when there is sufficient estrogen saturation in the body. The smear consists of keratinized or keratinized cells. Leukocytes and basal cells are absent, and there are a small number of intermediate cells.

After ovulation vaginal epithelial cells (intermediate) are located in large groups, their edges are rolled up: there is pronounced granularity in the cytoplasm.

Corresponding index calculated by counting 100, 200 or 500 cells in the colpocytogram. In this way, the index of keratinized cells with pyknotic nuclei is determined. total number cells, or karyopyknotic index(CPI), indexes of intermediate cells and atrophic or basal. The maturation index (MI) is presented, for example, in the form of a formula - 5/20/75, which indicates the number of parabasal, intermediate and superficial cells per 100 counted.

Shift this formulas to the left means an increase in the number of immature cells, to the right - an increase in maturity, which occurs under the influence of estrogenic hormones. Along with identifying the number of cells of different layers of the vaginal epithelium among the cells surface layers with polychrome staining, the acidophilic and basophilic index is calculated. The index is calculated under high magnification (43x10).

In normal menstrual cycle before the onset of menstruation, the average CPI indicators are 30%, and after the end - 20-25%; by the time of ovulation they fluctuate between 60-85%. The acidophilic index at the time of ovulation is most often 30-45%.
When studying colpocytograms It is advisable to use the simplified diagram below.

Submitted criteria Colpocytogram scores are used to characterize ovarian function in women childbearing age. In women of adolescence during menopausal changes menstrual function and after the onset of menopause, it is more appropriate, following the recommendation of M. G. Arsenyeva, to give a detailed description of colpocytograms highlighting smears of proliferative, cytolytic, intermediate, atrophic, mixed and androgenic types.

Strokes proliferative type consist predominantly of cells of the superficial layer, sometimes arranged in groups, sometimes separately. The CPI and eosinophilic index can be high, but sometimes eosinophilia does not exceed 10%. These strokes indicate high level estrogenic influences and, according to the observations of M. G. Arsenyeva, occur in every fourth woman within the first 5 years of menopause.

Cytological smears, in which fragments of the cytoplasm of destroyed cells and separately lying “naked” nuclei are found, occur with a decrease in the level of estrogenic influences or with a combination of estrogen-androgenic influences.

Intermediate smears consist predominantly of intermediate cells with a large round or oval nucleus, arranged in groups or layers. The CPI is within 5-15%, the eosinophilic index does not exceed 10%.
Atrophic type smears, contain mainly basal and parabasal cells and leukocytes; intermediate cells are found.

IN strokes mixed type All types of cells can be found: basal, intermediate and a small number of keratinizing cells of the superficial layers. According to M. G. Arsenyeva, this type of colpocytogram characterizes weak estrogenic stimulation against the background of moderate androgenic stimulation from the adrenal cortex.

Androgenic smears consist of intermediate cells with large nuclei and a small number of basal cells. More often they are found in postmenopausal women against the background of increased excretion of 17-KS in the urine.

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