Obstetrics and Gynecology - A.M. Gromova 2000

Anatomical and physiological features of the female body
Methods of functional diagnostics

Functional diagnostic Methods in gynecology make it possible to diagnose Disorders of the Reproductive System and also play a crucial role in monitoring the outcomes of functional therapy.

1. Examination of cervical mucus secretions.

Throughout the Menstrual cycle, The properties of cervical mucus change under METABOLISM/18.html">The Influence of estrogens and progesterone. In a 28-day cycle, mucus secretion begins on days 8–9, increases in volume between days 9 and 14, then sharply decreases, and ceases entirely by days 18–19.

2. The spinnbarkeit (mucus stretch) test.

When mucus is retrieved from the cervical canal using forceps tips and the blades are gently separated, a thread is formed whose length depends on the viscosity of the mucus. The maximum thread length is achieved during ovulation. Thus, the presence of stretchable mucus in the cervical canal indicates proper corpus luteum function.

3. The "pupil" sign.

During the menstrual cycle, the tone of the cervix changes under the influence of Steroid Hormones. By days 10–14 of the cycle, the external cervical os widens to about 0.3 cm in diameter, becomes rounded, and appears glossy. A drop of mucus protruding from the external os appears dark when light is directed at it, resembling a pupil (a positive "pupil" sign). In the subsequent days of the cycle, The amount of mucus in the cervical opening decreases, and by days 18–19 the os closes, the mucus disappears, and the cervix becomes dry (a negative "pupil" sign).

4. The "fern" phenomenon (arborization test).

This test is based on qualitative changes in cervical canal secretions that occur under the influence of Sex Hormones during different Phases of the menstrual cycle, obeying the general laws of crystallization of all elements. The "fern" phenomenon serves as a diagnostic test for estrogen activity.

A drop of cervical mucus placed on a Microscope slide exhibits, after drying, a characteristic microscopic pattern resembling a fern leaf. Crystallization of the mucus is caused by the interaction of mucin and sodium chloride. The chloride content secreted into the Vagina increases sharply toward the middle of the menstrual cycle (from 0.1% to 1.5%), driven by estrogen levels.

Smears may appear in the following forms:

a) isolated stems (when estrogen secretion is scant);

b) a pronounced leaf pattern;

c) thick stems with distinct leaflets branching off at a 90° angle (during ovulation, when estrogen production peaks).

5. The "spot" test (chloride content in cervical mucus).

The "spot" test is based on the fluctuation of chloride content in cervical mucus throughout the menstrual cycle. The concentration of sodium chloride increases under the influence of estrogens at the time of ovulation and is minimal or absent in cases of estrogen deficiency. In a normal menstrual cycle, the "spot" test is positive throughout the follicular phase, and on the day of ovulation, the sodium chloride concentration rises to 1.5%.

In anovulatory cycles, the "spot" test remains positive throughout the cycle, but the concentration does not exceed 1%. In cases of estrogen deficiency, the loop test is negative.

6. Basal body Temperature.

Basal body temperature measurement relies on The Effect of progesterone on the thermoregulatory center in the Hypothalamus. It is measured rectally in the morning before getting out of bed, using the same thermometer on an empty Stomach. During phase I of the menstrual cycle, the temperature is below 37°C (by 0.2–0.3°C); following ovulation, it rises by 0.6–0.8°C and remains within 37.1–37.4°C. 1–2 days before menstruation, the temperature drops back to baseline levels, demonstrating a biphasic temperature curve—estrogens lower it, while progesterone raises it.

7. Hormonal colpocytology – detailed in section 30.2.

Review Questions

1. Name the external genitalia.

2. Name the internal genitalia.

3. The Uterus and its constituent parts.

4. The Blood Vessels of the uterus.

5. The Ovary: shape, dimensions, blood vessels, and nerves.

6. Functional role of the vagina.

7. Functional role of the ovary.

8. Fallopian tubes and their function.

9. Name the blood Vessels of the internal genitalia.

10. Name the blood vessels of the external genitalia.

11. Innervation of the external genitalia.

12. Definition of the menstrual cycle and its characteristics.

13. Ovarian changes during the 1st and 2nd phases of the menstrual cycle.

14. Phases of corpus luteum development.

15. Changes in the endometrium throughout the menstrual cycle.

16. Interrelation between the ovarian and uterine phases.

17. The Role of the Central Nervous system and hypothalamus in the Regulation of the menstrual cycle.

18. Regulation of the menstrual cycle.

19. Pituitary and Ovarian Hormones.

20. Diagnostic tests for assessing ovarian function.