NURG 603 CERVIX EXAM 20240-2025
Define cervical agenesis.
a. An absent uterine cervix with a normal uterine corpus and normal vagina
b. Very rare
Why was DES given? What are some common complaints/anomalies of women
who were exposed to DES in utero?
a. It was used between the 1940s and 1971 to PREVENT PREMATURE BIRTH,
MISCARRIAGES, and other obstetric complications.
b. In utero exposure to DES is most commonly associated with
i. Development of vaginal clear cell carcinoma in female offspring
ii. structural changes of the cervix including collars, hoods, cockscombs,
pseudopolyps, cervical hypoplasia, and transverse septa
iii. anomalies of the uterus including T-shaped uterine cavity, hypoplastic uterus,
adhesions, and constrictions of the uterine cavity
iv. increased risk of infertility with cervical abnormalities
v. with pregnancy, increased risk of miscarriage, ectopic pregnancy, and premature
delivery due to cervical incompetence (treated with prophylactic cervical cerclage)
Review cervical lacerations.
a. Frequent complication of vaginal delivery
b. The lateral aspect of the cervix is the most common site
c. Associated with vaginal bleeding, and may require suturing after delivery (<5%)
d. Individuals at increased risk for cervical lacerations: cervical cerclage,
precipitous labour, operative delivery w/ vacuum or forceps, nulliparity, and
,episiotomy, D&C (mostly on postmenopausal: misoprostol should be used
preoperatively to soften the cervix), operative hysteroscopy
e. If a laceration extends to the lower uterine segment or vaginal wall it warrants
repair
i. Small asymptomatic lacerations do not need to be repaired
ii. Repair of lacerations lessens the risk of cervical stenosis and cervical
incompetence
iii. Can also be managed with direct pressure and ferric subsulphate solution
f. Hemorrhage is the most serious complication, rare
g. Do not affect the outcome of subsequent pregnancies
Define cervical ectopy.
a. When the squamocolumnar junction (normally on the ectocervix) extends to
replace a large part of the ectocervix
i. Cervix will appear red, granular and inflamed
ii. This change occurs through the process of squamous metaplasia where the
columnar epithelium is gradually converted to stratified squamous epithelium
iii. On colposcopy it has a fine villiform pattern
iv. This change may be accelerated during fetal existence, adolescence, and during
the first pregnancy
What are the most common pathogens that cause cervical infections?
a. Neisseria gonorrhoeae
b. Chlamydia trachomatis
c. Herpes simplex virus (HSV)
d. Human Papillomavirus (HPV)
e. Trichomoniasis
, f. Mycoplasma genitalium
g. Cytomegalovirus
h. Bacterial vaginosis
Which organism is considered “silent” because of the lack of symptoms
experienced by patients?
a. Cervicitis in general is often asymptomatic
b. CHLAMYDIA
c. May also be asymptomatic in some women with: gonorrhea, HSV, HPV, and
mycoplasma
What are two ways that patients can use to prevent cervicitis?
a. Abstinence and condoms/barrier method
Differentiate between acute and chronic cervicitis.
a. Chronic: only abnormal vaginal discharge is seen, the upper vagina appears
normal
b. Acute: patients with abnormal/purulent discharge. May also have vulvar burning
and itching, vaginal bleeding (mainly postcoital)
6. On colposcopic view: acute cervicitis reveals an altered micro angioarchitecture
with marked increase in surface capillaries that display a pattern of diffuse
“punctuation”
Discharge Appearance with conditions
1. Gonorrhea: thick creamy discharge with acutely inflamed and edematous cervix.
a. Can be accompanied by urethritis, frequency and urgency or dysuria
2. Trich: foamy greenish-white discharge with strawberry like the appearance of
the ectocervix extending into the vaginal mucosa
a. Colposcopic findings: double hairpin capillaries
Define cervical agenesis.
a. An absent uterine cervix with a normal uterine corpus and normal vagina
b. Very rare
Why was DES given? What are some common complaints/anomalies of women
who were exposed to DES in utero?
a. It was used between the 1940s and 1971 to PREVENT PREMATURE BIRTH,
MISCARRIAGES, and other obstetric complications.
b. In utero exposure to DES is most commonly associated with
i. Development of vaginal clear cell carcinoma in female offspring
ii. structural changes of the cervix including collars, hoods, cockscombs,
pseudopolyps, cervical hypoplasia, and transverse septa
iii. anomalies of the uterus including T-shaped uterine cavity, hypoplastic uterus,
adhesions, and constrictions of the uterine cavity
iv. increased risk of infertility with cervical abnormalities
v. with pregnancy, increased risk of miscarriage, ectopic pregnancy, and premature
delivery due to cervical incompetence (treated with prophylactic cervical cerclage)
Review cervical lacerations.
a. Frequent complication of vaginal delivery
b. The lateral aspect of the cervix is the most common site
c. Associated with vaginal bleeding, and may require suturing after delivery (<5%)
d. Individuals at increased risk for cervical lacerations: cervical cerclage,
precipitous labour, operative delivery w/ vacuum or forceps, nulliparity, and
,episiotomy, D&C (mostly on postmenopausal: misoprostol should be used
preoperatively to soften the cervix), operative hysteroscopy
e. If a laceration extends to the lower uterine segment or vaginal wall it warrants
repair
i. Small asymptomatic lacerations do not need to be repaired
ii. Repair of lacerations lessens the risk of cervical stenosis and cervical
incompetence
iii. Can also be managed with direct pressure and ferric subsulphate solution
f. Hemorrhage is the most serious complication, rare
g. Do not affect the outcome of subsequent pregnancies
Define cervical ectopy.
a. When the squamocolumnar junction (normally on the ectocervix) extends to
replace a large part of the ectocervix
i. Cervix will appear red, granular and inflamed
ii. This change occurs through the process of squamous metaplasia where the
columnar epithelium is gradually converted to stratified squamous epithelium
iii. On colposcopy it has a fine villiform pattern
iv. This change may be accelerated during fetal existence, adolescence, and during
the first pregnancy
What are the most common pathogens that cause cervical infections?
a. Neisseria gonorrhoeae
b. Chlamydia trachomatis
c. Herpes simplex virus (HSV)
d. Human Papillomavirus (HPV)
e. Trichomoniasis
, f. Mycoplasma genitalium
g. Cytomegalovirus
h. Bacterial vaginosis
Which organism is considered “silent” because of the lack of symptoms
experienced by patients?
a. Cervicitis in general is often asymptomatic
b. CHLAMYDIA
c. May also be asymptomatic in some women with: gonorrhea, HSV, HPV, and
mycoplasma
What are two ways that patients can use to prevent cervicitis?
a. Abstinence and condoms/barrier method
Differentiate between acute and chronic cervicitis.
a. Chronic: only abnormal vaginal discharge is seen, the upper vagina appears
normal
b. Acute: patients with abnormal/purulent discharge. May also have vulvar burning
and itching, vaginal bleeding (mainly postcoital)
6. On colposcopic view: acute cervicitis reveals an altered micro angioarchitecture
with marked increase in surface capillaries that display a pattern of diffuse
“punctuation”
Discharge Appearance with conditions
1. Gonorrhea: thick creamy discharge with acutely inflamed and edematous cervix.
a. Can be accompanied by urethritis, frequency and urgency or dysuria
2. Trich: foamy greenish-white discharge with strawberry like the appearance of
the ectocervix extending into the vaginal mucosa
a. Colposcopic findings: double hairpin capillaries
