cervical mucus exam.pptx

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1. CERVICAL MUCUS EXAMINATION

2. CERVICAL MUCUS EXAMINATION INTRODUCTION cervical mucus is produced by cervix when the hormone estrogen rises. Estrogen level is begins low, then climes to its peak at ovulation before dropping again. The most important aspect is that vaginal & cervical dryness is often left un-noticed and that can lead to infertility.

3. CERVICAL MUCUS EXAMINATION Cervical mucus is secreted by the columnar lining of the cervix Endocervical glands :20-60 ml/day 600 ml around the time of ovulation

4. CERVICAL MUCUS EXAMINATION ROLE OF CERVICAL MUCUS Receptivity: To sperm penetration at, or near, ovulation and interference with penetration at other times. Sperm protection: Hostile environment of the vagina. Energy supplementation Filtration: Sperm selection (motility and morphology). Reservoir: Short term sperm reservoir. capacitation

5. CERVICAL MUCUS EXAMINATION INDICATIONS Bacteriological Study Hormonal Status Infertility Investigation

6. CERVICAL MUCUS EXAMINATION Bacteriological Study Cusco’s bivalve speculum is introduced without lubricant. w ith the help of a sterile cotton swab, the cervical canal is swabbed The material is either sent for a culture or spread over a microscope slide for gram staining

7. CERVICAL MUCUS EXAMINATION Hormonal Status The physical, chemical and cellular components of the cervical secretions are dependent on hormones-estrogens and progesterone. Oestrogen increases the water and electrolyte content with decreases in protein. As, such the mucus become copious, clear and thin.

8. CERVICAL MUCUS EXAMINATION Progesterone on the other hand ,decreases the water and electrolytes but increases the protein. As, a result the mucous becomes scanty, thick and tenacious. The influence of the hormones on the cervical mucous is utilized in detection of ovulation in clinical practice. The around the time of ovulation is about 6.8 – 7.4.

9. CERVICAL MUCUS EXAMINATION Spinnbarkelt (stretch ability or elasticity) During the mid cycle, the cervical secretion is collected with a pippete and placed over a glass slide. Another glass slide is placed over it.Because of increased elasticity due to high estrogen level during the period, the mucus placed between the slides can withdrawn stretching up to a distance of over 10 cm After ovulation, when corpus luteum forms, progesterone is secreted. Under its action, the cervical mucus loses its property of elasticity and the mucus fractures if the same is attempted. This loss of elasticity after its presence in the mid cycle is the indirect evidence of ovulation.

10. CERVICAL MUCUS EXAMINATION FREN TEST During the midcycle,the cervical mucus is obtained by a platinum loop or pipette and spread on a clean glass slide and dried. When seen under low powder microscope it shows characteristic pattern of fern formation It is due to high sodium chloride and low protein content in the mucus due to high estrogen in the midmenstrual phase prior to ovulation. After ovulation with increasing progestron,the ferning disappears completely after 21 st day. Thus, the presence of ferning even after 21 st day suggests anovulation and its disappearance is presumptive evidence of ovulation.

11. CERVICAL MUCUS EXAMINATION INFERTILITY INVESTIGATIONS Post coital test The patient should report to the clinic preferably within 8-12 hours of following intercourse. The cervix is exposed with a cuscus speculum, using a polyethylene catheter attached to syringe. The endocervical mucus is collected and placed over a warm glass slide and its examined microscopically. Presence of at least 10 progressively motile sperms signifies the test to be normal Absence of ant sperm signifies either aspermia or imperfect coital techniques and the test should be repeated and examined within 2-4 hours of inter course Presence of immotile sperm with a normal sperm count in a good quality of cervical mucus signifies presence of immunological factors