Delaying Pap Test Screening in the Adolescent Population: An Evidence-Based Approach

Cervical cancer screening guidelines have evolved significantly over the past ten years in the adolescent population. The objective of this article is to review the cervical screening guidelines in the adolescent population as well as examine the evidence and studies that support delaying screening until 21 years old. Delaying HPV and Papanicolaou testing until 21 years old is safe and will not increase cervical cancer rates in the adolescent population.     

Moving Beyond the Pain: Women's Responses to the Perinatal Period After Childhood Sexual Abuse

Introduction: Childhood sexual abuse (CSA), a significant public health problem, affects 1 in 9 women presenting for prenatal care. Female survivors of CSA often experience posttraumatic stress disorder. Flashbacks of the trauma can interfere with a survivor's ability to get appropriate perinatal care. The purpose of this study was to construct a theoretical framework describing how CSA survivors manage intrusive reexperiencing of their CSA trauma during the perinatal period. Methods: Grounded theory was used to construct the framework of this study. Twelve women, aged 18 to 39 years, who were pregnant or gave birth within 12 months of the interview and self‐identified as having experienced CSA were recruited. Open‐ended interviews were conducted. Participants were asked to describe the CSA experience and how it affected them during the perinatal period. Constant comparison analysis was used to construct the framework. Results: The study framework depicts how pregnant survivors of CSA manage the intrusive reexperiencing of CSA triggered during the perinatal period by 3 processes categorized as reliving it, taking charge of it, and getting over it. Discussion: This framework suggests that survivors can begin to move beyond the pain of posttraumatic stress disorder, a mental health sequelae of CSA, during the perinatal period. Practitioners can use this framework to tailor interventions to the phase of the survivor's current experience.     

The quality of the Pap smear.

Three methods of cervical Pap smear have been studied: the classical spatula, the combination of spatula and cytobrush, and the Cervex-Brush. Thirty-two percent of the spatula smears did not provide endocervical cylinder cells. Significantly better results can be achieved by performing the smear with a combination of spatula and cytobrush (11% without cylinder cells), or with Cervex-Brush (15% without cylinder cells). Cervical smears using a spatula alone are therefore discouraged.     

Moving Beyond the Debate: A Holistic Approach to Understanding and Treating Effects of Neuraxial Analgesia

Neuraxial analgesia is here to stay, yet, spirited debate continues over potential harms and the quality of research that fails to identify them. This paper proposes moving beyond the debate and examining holistically the impact of neuraxial analgesia on the psychophysiology of mother and baby. A review of alterations in functioning of many systems is followed by a suggested four‐part protocol to partially restore normal physiology and emotional well‐being, and improve outcomes of neuraxial analgesia. (BIRTH 39:4 December 2012)     

The primary-care physician and cancer detection: the role of the Pap smear

This is a retrospective 5 year study of cancer detection in the suburban office of a primary-care physician. There were 127 diagnoses of malignancy confirmed in 5,011 patients, 62 in the reproductive system and 62 in other organ systems. More than 9,000 Pap smears resulted in the final diagnosis of carcinoma of the cervix in only seven patients. 374 curettages yielded 37 cases of endometrial carcinoma. All of these patients had Class I Pap smears preoperatively.     

MIDWIFERY ASSESSMENT OF THE WELL WOMAN: The Pap Smear

As more women have their well woman gynecologic needs met by CNMs, the impact of the midwife's role as a coordinator of women's health care becomes clearly evident. Midwives must become experts in screening women of all ages for a variety of health care concerns and they must be versed in many aspects of gynecologic care, beginning with the Pap smear. As the incidence of human papilloma virus has increased significantly in recent years, so has the incidence of cervical dysplasia. Understanding the epidemiologic factors for cervical dysplasia and the courses of therapy used are integral parts of comprehensive nurse-midwifery care.     

Midwifery assessment of the well woman. The Pap smear

As more women have their well woman gynecologic needs met by CNMs, the impact of the midwife's role as a coordinator of women's health care becomes clearly evident. Midwives must become experts in screening women of all ages for a variety of health care concerns and they must be versed in many aspects of gynecologic care, beginning with the Pap smear. As the incidence of human papilloma virus has increased significantly in recent years, so has the incidence of cervical dysplasia. Understanding the epidemiologic factors for cervical dysplasia and the courses of therapy used are integral parts of comprehensive nurse-midwifery care.     

Management of the mildly abnormal Pap smear: a conservative approach

Follow-up and management of the mildly abnormal Pap smear has been the subject of controversy in the medical literature. At Fitzsimons Army Medical Center, patients with initial Pap smears reported as "inflammatory atypia" or mild dysplasia were treated with specific therapy for vaginitis and/or cervicitis. Follow-up smears were performed 6 to 8 weeks later. Of the above groups, 80 and 58%, respectively, were negative on repeat smear. A third group of patients with Pap smears reported as consistent with human papillomavirus (HPV) were not treated but had repeat smears performed at 6 to 8 weeks. Of these, 76.4% reverted to normal. The results of the colposcopically directed cervical biopsies obtained on patients with persistently abnormal smears are reported. These findings support a conservative plan for follow-up of mildly abnormal Pap smears.     

Beyond Evidence: The Complexity of Maternity Care

Preface: This paper has been gestating for a long time‐‐the sixty years that I have been associated with maternity care. It was conceived during an era of medical authoritarianism, born in a time of nascent childbirth education and family‐centered maternity care, matured in a period of enthusiastic (but not unquestioning) homage to evidence‐based obstetrics, and culminated in a reluctant but comforting acceptance of uncertainty. It has passed through stages of enthusiasm, of disillusionment, and of reevaluation. It is, to use an ancient word I only recently learned, a clinamen, a swerve, a point of intellectual revision. Others in the Clinamen Collaboration share the authorship of this paper with me. Murray Enkin     

The prevalence of HR-HPV DNA in ASC-US Pap smears: A military population study

OBJECTIVE: To determine the prevalence of HR-HPV DNA in ASC-US Pap smears following implementation of the Bethesda 2001 classification system. METHODS: A computer database of Pap smears obtained within Department of the Army medical facilities was queried for the study period August 2002 to June 2004. All ASC-US Pap smears that underwent reflex testing for HR-HPV DNA were included. Additional clinical and demographic data were obtained from facilities within the US northeast region to evaluate the differences in ASC-US and SIL rates between the current and former Bethesda classification systems. RESULTS: 550,000 Pap smears were collected during the study period. The HR-HPV prevalence was 40.8% (95% confidence interval [CI] = 40.3 to 41.3) among 40,870 patients with ASC-US Pap smears. Within the northeast region, the HR-HPV prevalence in ASC-US Pap smears decreased from 61.2% (95% CI = 57.4 to 64.8%) in patients 18-22 years old to 24.9% (95% CI = 23.1 to 26.8%) in patients age 29 and older. When comparing the two classification systems, significant increases in both ASC-H and SIL and decreases in ASC-US were appreciated after the institution of Bethesda system 2001. CONCLUSION: In our large, diverse cohort, the implementation of the Bethesda II system has resulted in a decrease in ASC-US Pap smear results. Additionally, the prevalence of HR-HPV in the ASC-US population was 40.8%, significantly lower than the rate noted in the ALTS trial under the Bethesda I classification system.