Cervical mucus examination
Cervical mucus is the secretion of the cervical gland. Under the influence of ovarian sex hormones, women of childbearing age with normal ovarian function have periodic changes in the physical and chemical properties of cervical mucus. Clinical observation of cervical mucus crystallization changes and mucus drawing tests by cervical mucus examination to understand ovarian function.Basic Information
Specialist classification: gynecological examination classification: vaginal secretion examination
Applicable gender: whether women are fasting: not fastingTips: Patients should be banned from vaginal medications and hormonal drugs before treatment to prevent the change of cell morphology from causing difficulties in diagnosis. Normal value
Crystallization is divided into 7 types:
Type I typical fern plant leaf crystal.
Type II is similar to Type I, but the branches are shorter and less similar to the shape of the branches after snow.
Type III is a very fine crystal with few branches and some like snapdragon. Mainly seen in the late menopause when the courtship is low.
Type IV crystals are relatively vague and resemble spoiled branches and leaves. It mainly appears after ovulation, and there are oval or prismatic objects and white blood cells on the film.
V-type is basically free of crystals, and white blood cells and crystal shadows can be seen under the microscope.
Type VI is mainly an elliptical or prismatic object. The long axis is aligned in a row, most of which occurs after ovulation and during pregnancy, and is more typical during pregnancy.
Type VII is mainly white blood cells and non-formed mucus, which appear before and after menstruation and menopause.Clinical significance
1. The 5th to 7th day of the menstrual period is very small, thick and turbid. In the dry specimens on the slides, only a lot of white blood cells and unformed mucus are seen.
2, the pre-ovulation period (follicular phase, the sixth to eighth day to the 14th day of the cycle) gradually increased, thin and transparent, high-like like egg-like, increased tensile force, can be pulled to about 10cm, crystallization from type III development To type I.
3, late ovulation (early corpus luteum, from the 14th day of the cycle to 20 to 22 days), the amount is small, the quality is thick, the transparency is obviously reduced, and the crystal is fuzzy and IV type. The ellipsoid is seen on the outside of the crystallized zone, and only the ellipsoid is seen when the crystallization disappears.
4, premenstrual period (the 22nd to 28th day of the cycle, that is, the middle and late luteal phase) mucus is thick, turbid, viscosity increases, the crystal disappears completely. Only ellipsoids arranged in rows were seen on the slides, and occasionally atypical crystals appeared in the first 1-2 days of menstruation.
5, the amount of mucus during pregnancy is small, the quality is viscous and frozen, can be seen from the type I evolution to the type VI process, or after the discovery of a typical ellipsoid for more than two weeks without menstrual cramps. If you see atypical crystallization during pregnancy, it suggests the possibility of threatened abortion. If there is a history of habitual abortion, there is no type I crystallization after pregnancy, indicating a good pregnancy prognosis.
6. In patients with amenorrhea, if there is a normal periodic change in cervical mucus, the ovarian function is good, and the cause of amenorrhea may be in the uterus.
7. Determine the ovarian secretion in the body and observe whether there is a certain regularity in the periodic changes of crystallization in normal menstruation. In the menstrual cycle, when the secretion is high, the cervical mucus gradually precipitates the crystal of the fern. During the menstrual period, the crystal of the fern disappears, and a small amount appears after the menstruation. After 14 days, it is the ovulation period, the content is the most, the most easy to find. It gradually disappeared later.
8, clinically used to observe a variety of ovarian secretion loss of disease to guide diagnosis and treatment; at the same time can be used as a reference for the diagnosis of ovulation, pregnancy and threatened abortion. After pregnancy, the dentate crystals should gradually disappear. If it does not disappear after 1 to 2 months, there is a possibility of threatened abortion.Precautions
Taboo before inspection:
1. Keep a normal diet and schedule, don't stay up late.
2, from the 7th day of the menstrual cycle to after ovulation to check, in order to understand the morphological changes of cervical mucus crystallization, the inspection time is longer, pay attention to go to the hospital on time.
3, patients should be prohibited before the examination of vaginal drugs and hormone drugs, in order to prevent changes in cell morphology to bring difficulties to the diagnosis.
Requirements for inspection:
You need to expose the cervix during the examination. You don't have to be too nervous at this time, so as not to bring too much difficulty to the doctor's work.Inspection process
Take the surface secretion of the cervix, smear with a dry cotton swab, high-poweroscopy, according to the white blood cells (or pus cells), crystal shadows and other tangible objects, can be roughly divided into 7 types.
Inspection result analysis
1. Appearance: After menstruation, the amount of cervical mucus is small, thick and turbid. The closer to the ovulation period, the more the secretion of cervical mucus, the thinner and more transparent. After ovulation, it will return to its original state.
2. The amount of cervical mucus: peaks before the increase in body temperature, about 0.3ml or more, and the body temperature rises rapidly after 1-2 days.
3. Drawing test: Apply the mucus to a dry glass slide, contact the mucus with a corner of the other slide, and gently pull up to observe the maximum length of the wire. The degree of drawing increases gradually from the menstrual period, and can be as long as 10-20 cm during ovulation.
4. Cervical mucus crystallization: The mucus is applied to the glass slide and naturally dried. Under the low magnification microscope, the typical fern-like or shingled crystals are present due to the high salt characteristics of the mucus, and there are more branches. Atypical is dendritic and thicker. Generally, crystallization begins to form 8 days before the temperature rises, and the closer to the ovulation period, the more typical and more obvious the crystallization. Estrogen promotes the formation of crystals, while progestogens and androgens inhibit.
5. Cytology: There are few cells in the cervical mucus during ovulation, and about 0-3 white blood cells per high power field. When there are many white blood cells, it is suspected that there is inflammation in the cervical canal and above.
6. Anti-sperm antibody: For patients with partial immune infertility, anti-sperm antibodies can be detected in cervical mucus.
7. Chemical composition analysis: The pH value of cervical mucus, protein, sugar, mucin, chloride and other contents also change periodically.Not suitable for the crowd
Menstruating women should not be tested.Adverse reactions and risks
When the cervical erosion is collected, the action should be gentle, avoiding excessive force or roughness to cause local bleeding.