Vaginal smear reactions. Karyopyknotic index (KPI), maturation index (MI)

Threat of miscarriage is one of the most common diagnoses given to pregnant women. This diagnosis can be found in the exchange card of approximately half of women at some stage of pregnancy.

From the beginning of pregnancy to 28 weeks, a diagnosis of “threatened miscarriage” is made, from 28 to 37 weeks - “threatened premature birth”, since children born after 28 weeks are viable.

Currently, the frequency of threatened abortion is increasing. This is due to the active rhythm of modern life (many pregnant women have the same workload as before pregnancy), environmental factors, an increase in the number of pregnant women over 35 years of age, and the spread of infections.

Causes

There can be many reasons for the threat; it is not always possible to identify the main one.

* In case of genetic pathology of the fetus, most often the threat of miscarriage continues despite the therapy, and as a result, either a miscarriage occurs or pregnancy regression (the fetus dies and the pregnancy does not develop further). If the pregnancy can be maintained, but the threat of miscarriage has been ongoing for a long time, you need to be wary of possible fetal malformations. In some countries, because of this, they consider it inappropriate to carry out maintenance therapy at all.

* Any infection during pregnancy increases the risk of miscarriage or premature birth. This is especially true for infections of the genital organs, because the infection through the genital tract can rise higher, reaching the uterus and fertilized egg. General infections of the body also play a role, especially those that cause fetal malformations (eg, rubella, toxoplasma, cytomegalovirus). Other infections are less dangerous, but nevertheless they also increase the risk of miscarriage and miscarriage. Therefore, even before pregnancy, you need to try to treat foci of chronic infection (dental caries, chronic pharyngitis, etc.).

* There can be many hormonal reasons. Most often, the threat of miscarriage is caused by a lack of progesterone, which is often called the “pregnancy hormone”. But there may be other hormonal reasons, such as an increase in the level of male sex hormones, disruption of the thyroid gland and other hormone-producing organs (pituitary gland, hypothalamus, adrenal glands).

* With malformations of the uterus (bicornuate uterus, saddle uterus, septum in the uterine cavity), the threat of miscarriage occurs more often, since the irregular shape of the uterus interferes with the normal attachment of the fertilized egg. The same applies to other diseases of the uterus - uterine fibroids, endometriosis, inflammatory processes.

* The risk of threatened abortion and miscarriage is increased with disorders in the blood coagulation system. Increased blood clotting leads to the formation of microthrombi in the placenta, which can cause an abruption site.

* Women with chronic diseases have a higher risk of miscarriage than healthy women. Therefore, it is important to treat or compensate for chronic diseases if possible before pregnancy.

* The threat of miscarriage during pregnancy can be provoked by acute emotional shock or a state of chronic stress, so it is not for nothing that they say that it is harmful for pregnant women to be nervous.

* Occupational hazards such as noise, vibration, contact with harmful chemicals, radiation are important, as they affect the course of pregnancy. Bad habits (smoking, drinking alcohol) also increase the risk of miscarriage.

Symptoms

The most common symptom of threatened miscarriage is uterine tension. It can manifest itself in different ways. In the early stages, this is usually felt as pain in the lower abdomen or lumbar region. When the uterus grows, a woman, in addition to nagging pain, can feel how her stomach becomes like stone, the uterus sharply protrudes. Sometimes uterine tension is detected by ultrasound, this is called uterine hypertonicity. Hypertonicity can be general, when the entire uterus is tense, or local, when some area is tense.

A rarer and more dangerous symptom is bleeding. Normally, scanty spotting is acceptable during the expected period. In other cases, discharge may be a sign of partial detachment of the ovum, this is determined by ultrasound. Bright discharge indicates a fresh detachment, dark brown discharge indicates an old detachment, when a hematoma (accumulation of blood) forms, which gradually empties. The cause of spotting in the first trimester may also be low attachment of the fertilized egg (which in itself increases the risk of threat).

You can read about bleeding during pregnancy in the article

During the examination, the doctor must determine what is causing the pain. Pain in the lower abdomen can be due to dysfunction of the intestines, pain in the lower back - due to osteochondrosis. Minor pain in the lower abdomen on the sides is usually caused by stretching of the uterine ligaments, and not by tension in the uterus itself. If there is bloody discharge, the doctor must determine whether it is flowing from the cervical canal, or whether the cause of the discharge is easily traumatic erosion of the cervix.

Women with an increased risk of miscarriage are recommended to measure the temperature in the rectum in the early stages. Normally it should be above 37 0.

In the hospital, a woman must undergo a smear test to determine the risk, which determines the karyopyknotic index - KPI. KPI is an indicator of the hormonal saturation of the body. This method can only be considered auxiliary, since it is often uninformative. For non-hormonal reasons, the smear may be normal even if there is a threat of interruption. The opposite situation, when a smear indicates a threat in the absence of one, may occur with an inflammatory process of the vagina. Quite often, the smear is simply wrong, and when taken again it shows a different result.

According to indications, hormonal levels are studied and infection is detected. In addition, during the examination, a woman undergoes a coagulogram in order to assess the state of the coagulation system, this is especially important if previous pregnancies ended in miscarriages.

Treatment

If you detect any symptoms of threatened termination, you should immediately consult a doctor. If bleeding occurs at any stage of pregnancy, it is recommended to call an ambulance.

Most often, treatment for the threat of interruption is carried out in a hospital. Only if the pain in the lower abdomen is of low intensity, there is no bloody or spotting discharge, you can be treated at home. However, if the symptoms of the threat cannot be eliminated at home, hospitalization is required.

Local hypertonicity, detected only by ultrasound, when nothing bothers the woman, does not require hospitalization. This symptom often appears because a woman has been waiting in line for an ultrasound for a long time.

If nagging pain in the lower abdomen appears after physical activity, you can take the No-shpa tablet on your own, or you can put a suppository with Papaverine, but if this situation repeats, you should consult a doctor.

If there is a threat of miscarriage, it is important to be at rest as much as possible, lie down more, and get enough rest. Physical activity should be avoided, including homework. Also, if there is a threat of miscarriage, you cannot have sex. Rest and proper routine are 80% of success in treating the threat of interruption. That is why the threat of interruption is most often treated in a hospital. There, a woman, willy-nilly, has to mostly lie down, while at home most women cannot help but do household chores. You can return to your normal lifestyle after the symptoms of the threat of interruption completely disappear.

Drug treatment of the threat depends on the stage of pregnancy.

In the first trimester, bleeding occurs more often. In this case, hemostatic agents (Dicinon, Vikasol, Tranexam) are used.

In case of nagging pain or hypertonicity of the uterus, according to ultrasound, the complex of preservative therapy includes antispasmodics - No-shpu, Papaverine or Platiphylline. In hospitals, injections are more often used, since with the injection method the drug begins to act faster.

If the doctor suspects that the cause of the threat is hormonal deficiency, progesterone drugs - Duphaston or Utrozhestan - are prescribed. Typically, progesterone preparations are used until 16 weeks of pregnancy, since after this period the placenta is formed, which itself produces the necessary hormones. Hormonal medications should be discontinued by gradually reducing the dose; abrupt withdrawal may lead to the return of symptoms threatening interruption.

After 12 weeks, magnesium drips are often prescribed (before this period they are ineffective). Magnesia provides relaxation of the uterus and improves uteroplacental blood flow. After discharge from the hospital, maintenance therapy with magnesium preparations (Magne B6, Magnerot) is often prescribed to relax the uterus and prevent a recurrent threat of miscarriage.

In later stages of pregnancy, drugs are used that act on specific receptors in the uterus, thereby reducing the contractile activity of the uterus. The most common of them is Ginipral. Used with a dropper starting in the second trimester of pregnancy. After eliminating the symptoms of the threat, maintenance therapy with Ginipral tablets is prescribed. In the first trimester, Ginipral is contraindicated.

If an infectious factor is suspected, antibiotic therapy is prescribed. It is not always possible to identify an infectious agent (virus or bacteria), because there are a lot of microorganisms, and it is impossible to identify everything. Therefore, sometimes even if no infection can be detected by conventional diagnostic methods, but the threat of interruption remains, despite the treatment, antibiotics can be prescribed. They are usually prescribed from the second trimester of pregnancy, since at the beginning of pregnancy, when all the organs and systems of the fetus are developing, the use of drugs should be kept to a minimum.

Since anxiety and worry contribute to the development of the threat of interruption, sedatives (motherwort, valerian) are included in the complex of preservative therapy. It is better to buy the herb and brew it yourself; this decoction works better than tinctures or tablets.

Sometimes physiotherapy is used (magnesium electrophoresis, electrorelaxation of the uterus, Shcherbak collar).

Although there is an opinion that if there is a threat of miscarriage, the further development of pregnancy does not depend on the treatment measures taken, it is better not to refuse treatment. This statement is true in the case of genetic pathology and chromosomal abnormalities in the fetus; in other cases, timely treatment can really help.

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

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 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.

Preparation 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.

Cytological examination of hormonal levels (if there is a threat of miscarriage, cycle disorders)

Determination of the cellular composition and ratio of cells of different layers of the epithelium in a vaginal smear. Reflects the functional state of the ovaries and allows you to assess the level of estrogen and progesterone in the body.

Synonyms Russian

Hormonal colpocytology, "hormonal mirror".

SynonymsEnglish

Endocrine Colpocytology; Vaginal Cytology.

Methodresearch

cytological method.

What biomaterial can be used for research?

Urogenital smear.

How to properly prepare for research?

No preparation required.

General information about the study

Hormonal cytological diagnostics is based on the study of sloughing vaginal epithelial cells, changes in their composition and ratio, depending on cyclic changes in the level of female sex hormones.

In the vaginal epithelium, according to morphological characteristics, four types of cells are distinguished: keratinizing (superficial), intermediate, parabasal and basal. Based on the ratio of these epithelial cells, the functional state of the ovaries is judged, since the maturation of these cells is under the control of estrogens. An increase in the level of estrogen in the blood promotes keratinization of the surface cells of the vaginal epithelium.

In hormonal colpocytology, several indices are assessed.

Maturation Index (MI)– the percentage of superficial, intermediate and basal (or parabasal) cells in the smear, which reflects the degree of epithelial proliferation. IS is determined by counting 100-200 cells in at least 5-8 fields of view. It is indicated in the form of a formula, where the percentage of parabasal cells is written on the left, intermediate cells in the middle, and superficial cells on the right. In the absence of any type of cell, the number 0 is placed in the corresponding place. During the peak of estrogen saturation due to an increase in surface cells, the IS corresponds to 70/30/0 or 90/10/0. Estrogen deficiency is defined by a ratio of 0/40/60 or even 0/0/100.

Karyopyknotic index (KPI or CI)– percentage of superficial cells with pyknotic nuclei and cells with vesicular nuclei. CPI reflects estrogen saturation, since estrogens lead to karyopyknosis (condensation of the chromatin structure) of the nucleus of vaginal epithelial cells. During the normal menstrual cycle, the CPI changes: during the follicular phase it is 25-30%, during ovulation - 60-80%, in the progesterone phase - 25-30%.

Eosinophilic index (EI)– percentage of superficial cells with eosinophilic cytoplasm to cells with basophilic cytoplasm. This indicator also characterizes estrogen saturation and before the onset of ovulation it is 30-45%.

Crowding index– the ratio of mature cells located in clusters of 4 or more to mature cells located separately, which characterizes the effect of progesterone on the epithelium. Marked in pluses or points: severe crowding (+++), moderate (++), weak (+).

Based on the cellular composition and ratio, there are several types of vaginal smears, which normally should correspond to the woman’s age and the phase of the menstrual cycle.

It is recommended to take smears for examination every 3-5 days for 2-3 menstrual cycles. For amenorrhea (absence of menstruation) and opsomenorea (infrequent menstruation), smears should be taken once a week. Colpocytological examination cannot be performed in case of vaginal inflammation or uterine bleeding, since the counting of vaginal epithelial cells will be complicated by the presence of a large number of leukocytes and endometrial fragments. For a cytological study of hormonal levels, smears from the anterolateral surface of the vagina are used, since the posterior vaginal fornix contains large quantities of secretion from the cervical glands. The material is taken by light scraping without pressing on the wall using a special applicator or spatula.

This method allows you to assess the correspondence of hormonal changes to age and phase of the cycle, judge the presence or absence of ovulation, prevent the threat of miscarriage and, if necessary, assess the effect of synthetic hormonal drugs and adjust treatment.

In a normal pregnancy, changes in the cytological smear should correspond to the gestational age. The appearance of uncharacteristic types of smears during pregnancy often precedes clinical signs of threatened miscarriage or premature birth.

What is the research used for?

To assess ovarian function and estrogen saturation of the body.
To diagnose the causes of miscarriage, infertility, and menstrual irregularities.
To diagnose hormonal changes during menopause.
To diagnose threatened miscarriage.
To assess the effectiveness of hormonal therapy.

When is the study scheduled?

For infertility.
During dynamic monitoring of a complicated pregnancy.
In case of menstrual irregularities (for example, amenorrhea, opsomenorrhea, dysfunctional uterine bleeding).
With menopausal syndrome.

What do the results mean?

The results must be interpreted taking into account the phase of the menstrual cycle, age, and stage of pregnancy.

There are several classifications of smear types.

1. According to the degree of estrogen saturation

Type I - the smear consists of basal cells and leukocytes, this is typical for severe estrogen deficiency.
Type II - the smear consists of parabasal cells, there are individual intermediate and basal cells, leukocytes - slight estrogen deficiency.
Type III – predominantly “intermediate” cells, single parabasal and keratinizing, are found, which indicates mild estrogen deficiency.
Type IV - the smear consists of keratinizing (superficial) cells, single intermediate ones; basal cells and leukocytes are absent, this indicates sufficient estrogen saturation.

2. According to the severity of atrophy

Severe atrophy - only parabasal cells are found in the smear, intermediate and superficial cells are absent, IS = 100/0/0.
Moderate atrophy - in smears, along with parabasal ones, there are cells of the intermediate layer, superficial cells are absent. IS = 80/20/0 or 65/35/0.
Moderate proliferation - parabasal cells are absent, intermediate cells predominate in the smear, SI = 0/80/20. Increased proliferative changes can be indicated by an arrow pointing to the right.
Pronounced proliferation - parabasal cells are absent, superficial cells predominate in the smear, IC = 0/15/85 or 0(0)100.

What can influence the result?

A distorted result may be obtained if:

smears were taken during menstruation and are represented by a large number of endometrial cells and blood;
smears taken during inflammatory diseases of the genital tract;
the preparations contain spermatozoa;
the smear is contaminated with spermicidal, antibacterial creams, lubricant from condoms, ultrasound gel;
a smear was taken after intravaginal manipulation;
the conditions for obtaining the material are not met;
careless preparation of the smear.

Important Notes

Cervical smears cannot be used for hormonal diagnostics.

Research cannot be carried out:

during the inflammatory process and after douching;
after any manipulation in the vagina;
within 48 hours after sexual intercourse;
with severe cytolysis, taking hormonal drugs (except for cases when the study is carried out to assess the adequacy of hormonal therapy and decide on its correction).

Menstrual cycle disorders (hormonal profile)
Pregnancy planning - hormonal tests

Who orders the study?

Gynecologist.

Literature

Likhachev V.K. Practical gynecology: A guide for doctors. – M.: Medical Information Agency LLC, 2007. – 664 p.
A manual for the practical development of obstetrics and gynecology / Ed. K.V. Voronina. – Dnepropetrovsk: Dnepr-VAL, 2001-219 p.
Gynecology / Ed. G. M. Savelyeva - M.: GEOTAR-MED, 2004. - 480 p.

1. Smear for general cytology.

Purpose: diagnostic

Objectives: taking smears from the urethra, cervical canal, vagina for bacterioscopic and colpocytological studies

Indications: determination of the state of vaginal biocenosis, diagnosis of inflammatory diseases

Equipment: soap, gloves, gynecological chair, mirrors, clean dry glass slide, bacteriological loop, Volkman spoon, warm saline solution (37˚C), containers with disinfectant solutions, direction indicating full name. patient, age, nature and date of material collection.

Methodology:

a) Write out the direction.

b) Wash your hands with soap and dry, put on gloves.

c) Place the patient on a gynecological chair in the dorso-gluteal position with legs apart and bent at the hip joints.

d) Initially, material is taken from the urethra, then the cervical canal and vagina.

e) Collection of material from the urethra. Insert the bacteriological loop into the urethra 2-3 cm, move the plane of the “eye” of the loop towards the opening, lightly pressing on the back and side walls of the urethra. Remove the loop and place it on the surface of the glass slide, moving it along it several times with light pressure.

f) Insert the speculum in a closed state to the entire depth of the vagina, open it and fix it in this position with a lock.

g) Collection of material from the vagina to prepare a native smear. Insert a bacteriological loop into the posterior or lateral vaginal fornix and take material. Apply a few drops of warm saline solution to the slide. Mix vaginal discharge with a drop of saline, cover with a coverslip and send to the laboratory.

h) Collection of material from the cervical canal. Insert the Volkmann spoon into the cervical canal 1-2 cm and rotate several times. Apply the resulting material to a glass slide and make a thin, even smear in the form of a horizontal stroke. Air dry.

i) Remove the speculum from the vagina.

j) Soak all used material: gloves, tools, soft equipment in a disinfectant solution.

k) Wash your hands with soap and dry.

2. Papanicolaou smear (Paptest) is a method of morphological analysis based on the study and evaluation of cellular material. The method makes it possible to assess the structure and cellular level of damage to tissues caught in the smear. Cytological criteria are based on the severity of signs of cellular atypia.

Identification of morphological features of cells characterizing a specific pathological process.

Indications:

Screening for cervical cancer (cervical cancer).

Preparing for the study:

During the day before the test, you should not douche or use vaginal medications. It is advisable to abstain from sexual intercourse for 1-2 days before the study. You cannot take material for research during menstruation.

To obtain the material, the following instruments are used: Eyre's spatula (for taking smears from the surface of the ectocervix), Volkmann spoon, screenet, endobranche (for taking endocervical smears, etc.).

To obtain optimal cytological results, samples should be taken separately from the ectocervix and endocervix. The material is taken before bimanual examination.

After inserting the speculum into the vagina, remove discharge from the surface of the cervix with a cotton swab. The tip of an Eyre spatula is inserted into the external uterine os, and the cellular composition is taken from the exocervix (from the stratified squamous epithelium) and the junction of the endocervix and exocervix (from the zone of metaplastic epithelium) with a 360-degree rotational movement with pressure. Then a special brush (cer-brash) is inserted into the cervical canal by 1-2 cm and material is taken from the walls of the cervical canal with a rotational movement. The resulting material is distributed in a thin layer on the surface of fat-free glass slides, marked in accordance with the place of collection. The smears are air dried.

Interpretation of results: classification of cervical smears according to Papanicolaou

First class - no atypical cells, normal cytological picture.

The second class is a change in the morphology of cellular elements caused by an inflammatory process in the vagina and/or cervix.

The third class is single cells with abnormalities of the cytoplasm and nuclei.

The fourth class is individual cells with obvious signs of malignancy: increased nuclear mass, cytoplasmic abnormalities, nuclear changes, chromosomal aberrations.

Fifth class - a large number of atypical cells are observed in the smear.

3. Method of taking smears for hormonal cytology.

The dynamics of changes in colpocytological parameters reflects the total fluctuation in the level of ovarian hormones in the body throughout the menstrual cycle. The method allows you to assess the level of estrogen, progestogen, and, in some cases, androgen saturation of the body.

The material is taken from the anterior fornix with a spatula or swab and evenly applied to a glass slide. A series of smears are taken in the dynamics of the menstrual cycle with a focus on its middle (ovulation dates): 4-9, 10-13, 14-15, 16-20, 21-28 days of the cycle. After polychrome staining, the ratio of parabasal, intermediate and superficial cells, expressed in the maturation index (MI), is examined in the smear. Karyopyknotic index (KPI) is the percentage of cells with small, pyknotic nuclei per 100 surface cells. Eosinophilic index (EI) - the percentage of eosinophilically stained cells of the superficial layers per 100 superficial cells. The maximum values of all three indicators at the time of ovulation: IS 0/15/85%, CPI - 80.7 ± 9.3, EI - 75.4 ± 0.6.

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, intermediate-type cells and leukocytes are found in small quantities. With moderate activity of estrogenic hormones, the third reaction is diagnosed. The smear consists of intermediate-type cells of various shapes and sizes; there are separate cell clusters.

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 cells of the vaginal epithelium (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 to the total number of cells, or karyopyknotic index (KPI), indices of intermediate cells and atrophic or basal cells is determined. 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 of the superficial layers using 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 assessments are used to characterize ovarian function in women of childbearing age. In women of adolescence, during the period of menopausal changes in 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.

Proliferative type smears 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 smears indicate a high level of 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 mixed strokes 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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