ABSTRACT
BACKGROUND: The objective of this study was to assess the efficacy of speculoscopy in screening pregnant adolescents for abnormal cervical pathology. METHODS: This was a prospective comparative study of the Papanicolaou smear and speculoscopy in pregnant adolescents (< 17 years of age at the time of examination) presenting for their initial obstetric visits. This study was conducted at private offices of a general obstetrics and gynecology academic practice. Interventions included Papanicolaou smears and speculoscopic examinations; patients with a positive result for either intervention were offered colposcopy. Main outcome measures were Papanicolaou smear and speculoscopy outcomes and results of colposcopy and cervical biopsies. RESULTS: Thirty consecutive pregnant adolescents were included in the study. Papanicolaou smears and speculoscopic examinations were well tolerated by all adolescents. Twenty-one adolescents had negative Papanicolaou smears and speculoscopic examinations, and one woman had a positive Papanicolaou smear and a negative speculoscopic examination. Four adolescents had positive speculoscopic examinations and negative Papanicolaou smears; of these cases, significant pathology was found in one case. Four adolescents had positive Papanicolaou smears and speculoscopic examinations, with significant pathology in two of these adolescents. CONCLUSION: This preliminary study shows speculoscopy to be well tolerated, not causing cervical trauma, and as effective as the Papanicolaou smear for detecting cervical pathology in pregnant adolescents.
Subject(s)
Mass Screening/methods , Papanicolaou Test , Physical Examination/methods , Precancerous Conditions/pathology , Pregnancy Complications, Neoplastic/pathology , Uterine Cervical Neoplasms/pathology , Vaginal Smears/methods , Adolescent , Age Factors , Biopsy/methods , Female , Humans , Pregnancy , Reproducibility of Results , Sensitivity and Specificity , Surveys and QuestionnairesABSTRACT
Extracellular matrix is a very complex assemblage of specialized molecules including collagen, elastin, proteoglycans, and attachment glycoproteins such as fibronectin and laminin. Collagen is an unusual protein because it requires multiple processing steps both within and outside the cell beginning with transcription and refinement of its messenger RNA, translation of the mature mRNA, extensive post-translational modifications, and further alterations in the extracellular compartments. If errors are made at any one of the multiple steps in this complex pathway, a defective molecule will be formed that could result in connective tissue abnormalities. Similarly, alterations in other components of the extracellular matrix can also result in clinical pathologies. Some of these clinical phenotypes have been classified as Ehlers-Danlos syndrome, Marfan syndrome, osteogenesis imperfecta, and epidermolysis bullosa. This article reviews these various connective tissue disorders, describes the underlying biochemical defects, and describes their impact on tissue repair.