What tests does the gynecologist prescribe? Standard tests from a gynecologist - important information about women's health
Since for every woman the state of her health is reproductive system is of great importance, then timely completion of gynecological examinations and tests can maintain her full functioning and give her a chance to become a mother.
Neglecting simple methods of protection and ignoring diagnostic examinations can cause such serious problems that can cause infertility and numerous health problems.
The importance of gynecological tests for infections
Sexual life is an integral part of human existence, and for a woman her intimate health is especially important, because she is destined by nature to become a mother. Infections can harm the woman’s health directly, making her ill, or affect the health of the unborn baby if infection occurs in utero or during childbirth or feeding.
Some infections may not affect a woman’s health in any way, but they can cause significant harm. Such diseases can cause numerous congenital deformities and pathologies, as well as provoke various diseases of the child in the future. Infections can affect all organs and tissues of the fetus. The placenta protects to some extent from some of them, but often infection can occur during childbirth, when the fetus passes through the mother's birth canal and comes into contact with blood and other fluids containing microorganisms.
In addition to affecting the fetus or child, sexually transmitted infections are transmitted from partner to partner and can cause infection of a large number of people.
If this is not detected in a timely manner, it can “populate” the entire body of a sick person with microorganisms and cause its degradation and death. A striking example of such infections is and.
Syphilis in its advanced form affects nervous system and causes the destruction of brain cells. A person in the final stages of this disease turns into his own likeness and then dies painfully. If left untreated, it develops into AIDS and also leads to death. With timely treatment, even such dangerous infections are either completely curable or leave a person a chance to live for several decades. Gynecological tests for infections make it possible to identify both obvious and hidden sources of diseases, as well as quickly deal with them.
Preparing for tests
A woman should understand that excessive attention to hygiene procedures can lead to a certain number of microorganisms being washed away or neutralized by the detergent. In order not to distort the result, it is recommended not to use douching or use aggressive or disinfectants before examining and taking biological material. detergents and do not wash too intensively, frequently or deeply. To carry out intimate hygiene, it is enough to use a neutral substance, and immediately before the analysis do not use any drugs, using only clean boiled water.
Taking a variety of medications, especially those that can affect the state of the microflora of the vagina and other organs, can also distort the picture of infection.
We are talking not only about specific drugs, for example, those used to treat thrush or others. Drugs that are usually used to treat colds, runny nose and cough can also affect test results. First of all, these are antibiotics, sulfonamide drugs, antivirals, drugs directed against fungal diseases, antitumor drugs and many others.
More information about testing for infections can be found in the video.
To properly conduct gynecological tests for infections, you should stop drinking alcohol at least 24 hours before. This is especially important in cases where a blood test is also added to the examination. Alcohol, tobacco, medications and an abundance of heavy food can affect the result, so a basic limitation of excesses will help to immediately get a clear and clear picture of the correct result.
If specific preparatory steps are required, the doctor will definitely explain to the patient what exactly she will need to do and what not to do.
Microflora smear
One of the oldest methods of taking gynecological tests for infections is the so-called.
Purpose of analysis:
- It is usually taken during a gynecological examination in a chair, as well as in cases where the patient complains of excessive genital discharge, unpleasant odor, type and color of discharge, itching of the external genitalia and anus, redness of the vulva and vagina.
- Also, such an analysis is carried out in cases where gynecological surgery or any serious procedures are planned.
This method of taking analyzes is attractive because it is carried out very quickly and gives quick results, however, it is already somewhat outdated. A smear shows only the presence of pathogenic microflora without specifying the results and their differentiation, which indicates the low information content of this method.
PCR method
Modern gynecological tests for infections include such an effective method as: It helps determine hidden infections, which do not manifest themselves in any way. Unfortunately, most sexually transmitted infections develop very secretly, without showing themselves for months and sometimes years.
Using the PCR method, it is possible to identify even single cells of pathogenic microorganisms and quickly take action against them.
This method will help cope with a variety of diseases long before they develop into a dangerous condition.
Sowing tank
Gynecological tests for infections, such as bacteriological culture, give more accurate results than a smear for flora. For something like tank sowing, you can take a variety of biological material. This could be the same vaginal smear or sample.
This analysis is called sowing because the resulting biological material is placed in a special nutrient medium. Microflora is grown in special, favorable conditions for a strictly defined time, and then analyzed.
A special feature of the culture tank is the fact that it can be used to “calculate” not only the causative agent of the disease, but also medicines that actively influence the development of microflora.
To do this, special tests and experiments are carried out with the resulting colony of microorganisms. They clearly and quickly show which of the medicines will be the most effective and will quickly help deal with pathogens.
Other types of tests for infections
Gynecological infections may also include. It can show general results, for example, the presence of an obvious or hidden infection in the body, the intensity of the inflammatory process, and possibly its duration.
This analysis is rarely used on its own, but is usually used as an additional analysis to provide a clearer picture.
Tests prescribed by a doctor help quickly and effectively identify the source of the disease and take adequate measures that will help the woman and her partner quickly recover and forget about their illness. Follow all the doctor’s instructions and your health will quickly return to normal, preserving the opportunity to have children and live a full, fulfilling life.
Gynecological tests will help determine the state of women's healthIt is impossible to say with complete confidence that a woman is healthy without a special medical examination. It is not always possible to make such a conclusion using the usual visual inspection or ultrasound examination. Clinical only laboratory tests will help determine the state of women's health.
Many women think that they should undergo gynecological tests only in case of obvious manifestations of any disease associated with dysfunction of the female reproductive system. This is not always the case. A woman who carefully monitors her health will turn to an in-depth gynecological examination if she is overweight, with the appearance of excessive hair, with a sharp change in skin condition and for many other reasons that, at first glance, are not directly related to the woman’s reproductive system. But this is only at first glance. General physical health, appearance, emotional state of a woman - all this directly depends on proper operation female reproductive system.
There are many reasons why a woman must undergo a cytological and biochemical examination:
When planning a pregnancy, it is important to do the necessary gynecological tests - mandatory preventive examination;
- violation menstrual cycle;
- determination of hormonal levels;
- selection of hormonal contraception;
- preparation and planning of pregnancy;
- pregnancy;
- uncomfortable conditions of the mammary glands;
- menopause;
- various neoplasms in the genital organs;
- state thyroid gland;
- underweight or overweight;
- hair loss and other reasons.
Choosing the right laboratory
The right choice laboratory deposit accurate results analyzes Any disease or deviation from the normal state that requires clarification of the cause must be diagnosed by your attending physician, who also determines a set of tests in a strict sequence. Therefore, looking for private laboratories on your own, interpreting tests from different doctors, changing laboratories in order to check the accuracy of the study is a waste of money, time and nerves. Therefore, start by finding your own gynecologist, whom you will completely trust, and who, in turn, will be interested in ridding you of your health problems. Such a doctor will refer you for examination only to a laboratory that he absolutely trusts.
The most common and mandatory gynecological tests
Important and mandatory gynecological tests The normal functioning of the female reproductive system depends, first of all, on the state of the flora internal organs, their correctness anatomical structure and hormonal levels. Therefore, to obtain a general picture of the patient’s health, a smear is taken for flora (this is a mandatory procedure during a preventive examination) and for more serious problems it is necessary to determine the hormonal status. If an in-depth comprehensive examination is carried out, a urine test, detailed blood tests and other appointments are required.
Why is a smear necessary for flora analysis?
This analysis is taken from the mucous membranes of a woman’s internal genital organs and is the most common during gynecological examinations.
Analysis of the cytological picture of the smear allows us to establish:
- analysis of the presence of bacteria of a certain shape and concentration;
- establish cells that are not characteristic of normal flora;
- do an initial analysis of the hormones present.
To ensure the purity of the test results, you should adhere to a number of rules: 1-2 days before taking a smear, you should refrain from sexual intercourse; do not use vaginal medications; You cannot take this test during bleeding, including menstrual bleeding; Douching is not recommended; don't take a bath. Before visiting a doctor, the genitals should only be washed with soap.
It is better to submit a smear for flora for processing to the same laboratory, especially if therapy is selected on its basis. To track the dynamics of treatment, a smear is taken before the start of treatment, during it and after its completion in order to track the body’s response to the prescribed medications or procedures.
Only your attending physician should decipher the smear result!
Average norms of flora indicators are calculated for women under fifty years of age. In girls who have not reached puberty, the composition of the microflora is completely different, and in women after 50 years, the smear results are significantly distorted due to hormonal imbalance.
If certain components are detected in a smear, the gynecologist makes a more accurate conclusion about the presence of the disease, especially if the patient complains, or prescribes additional research to clarify the diagnosis.
Here are some transcripts of the cytological picture of this analysis:
Mucus in the urethra is an indicator of inflammation of the urinary system - the inflammatory process is indicated by a large number of epithelial tissue cells;
- a large number of leukocytes in the field of study is also an indicator of inflammation of various nature;
- if mucus is found in the vagina, this is normal, but if it is found in the urethra, this is an indicator of inflammation of the urinary system;
- a lot of spherical bacteria (coccal flora) against the background of a significant decrease in rod-shaped bacteria indicates the presence of infection;
- sexually transmitted diseases are indicated by the detection of microorganisms such as gonococcus, gardnerella, trichomonas in a smear;
- a large number of yeast fungi are detected - candidiasis is diagnosed.
Thus, after analyzing the cytological analysis of flora, the gynecologist will make a conclusion about the presence of inflammatory processes of different nature, identify acute and chronic diseases, will draw a conclusion about the state immune system patients. With the help of this study, the degree of cleanliness of a woman’s vagina and, accordingly, her women’s health are determined. The first degree (normal) is determined by the presence of 95% lactobacilli; leukocytes and cells of epithelial tissue can be found only in isolated manifestations.
Cost of gynecological tests (data based on comparison of prices on the Internet)
| Blood type and Rh factor | 500 |
| general hCG | 500 |
General clinical blood tests | |
| Biochemical analysis shelter (standard) | 1800 |
| Clinical blood test | 500 |
| Clinical urine analysis | 300 |
Blood type and antibodies | |
| Blood type and Rh factor | 500 |
| Alloimmune anti-erythrocyte antibodies | 600 |
| Kell system antigens | 600 |
Hormones | |
Thyroid hormones | |
| Total triiodothyronine (T3 total) | 350 |
| Free triiodothyronine (FT3 - T3 free) | 350 |
| Total thyroxine (T4 total) | 350 |
| Free thyroxine (FT4 - T4 free) | 350 |
| Thyroid-stimulating hormone (TSH) | 350 |
| Antibodies to thyroglobulin (A/t - TG) | 500 |
| Antibodies to thyroid peroxidase (A/t-TPO) | 500 |
Reproduction hormones | |
| Prolactin | 400 |
| Luteinizing hormone (LH) | 400 |
| Follicle stimulating hormone (FSH) | 400 |
| Estradiol | 400 |
| Progesterone | 400 |
| Testosterone total | 400 |
| Dehydroepiandrosterone (DHEAS-S) | 400 |
| 17OH-Pg (17-hydroxyprogesterone) | 600 |
Pregnancy monitoring, fetal condition markers | |
| general hCG | 500 |
| Free estradiol | 600 |
| PAPP-A | 600 |
| Placental lactogen | 800 |
PCR studies | |
| Chlamydia trachomatis | 250 |
| Mycoplasma homonis | 250 |
| Mycoplasma genitalium | 250 |
| Ureaplasma urealiticum | 250 |
| Herpes simplex virus type 1+2 | 250 |
| Cytomegalovirus | 250 |
| Gardnerella | 250 |
| Trichomonas | 250 |
| Gonococcus | 250 |
| Mushrooms | 250 |
| Human papillomavirus types 6/11 | 250 |
| Human papillomavirus types 16/18 | 250 |
| Human papillomavirus types 16,18,31,33,35,39,45,51,56,58,59 | 1500 |
| Human papillomavirus types 31/33 | 250 |
| White treponema | 300 |
| Ur. parvum | 250 |
| Ureaplasma species | 250 |
| PCR research (14 positions) | 3000 |
“Women’s” diseases occur at any age. Therefore, you need to develop a good habit of visiting a gynecologist at least once, or preferably twice a year. Regular examinations will be the key to prevention serious illnesses. And it is impossible to determine whether everything is in order with women’s health without an analysis such as a gynecological smear.
The smears that a gynecologist can take during an examination can be divided into three groups, based on the purpose of the examination.
Cytological smear
The most important group is smears, which can be used to identify pre-tumor and tumor changes and diseases of the cervix. Simply put - on cancer cells, for oncology, for atypical cells, oncocytology, cytological smear, Pap test. These are the names of the same study.
A cytological smear is carried out in two ways: by applying a scraping from cervical canal and the surface of the cervix on a glass slide or using liquid cytology (the information content of this method is higher, there are fewer false-positive results).
In what cases is it prescribed? An oncocytology examination is recommended for all women once a year. If changes in the smear are detected, additional tests are prescribed.
How to prepare. To exclude errors, it is better to take a Pap test after the end of menstruation (if complete absence bloody discharge) and no less than 5 days before the onset of “these days”.
1-2 days before visiting a gynecologist, you should avoid sexual intercourse, inserting tampons and suppositories into the vagina.
Flora smear
The next group of smears is taken to determine the microflora of the vagina, in other words, the microbial composition of the vaginal contents and cervical canal. This is necessary to identify the inflammatory process and determine the causative agent of the pathology. The general name of these studies is a smear on the flora.
There are several types of such research:
1. Gynecological smear
With its help, they study the composition of vaginal secretions, determine the presence of epithelial cells, the number of leukocytes, the presence of normal flora (lactobacillus), microbial composition (bacillus, cocci and their ratio), opportunistic flora, pathogenic microorganisms (Trichomonas, gonococci).
In what cases is it prescribed? Mandatory - for pregnant women, patients before gynecological operations, before insertion or removal of an IUD, when referred for examination and treatment to a cervical pathology office, etc.
According to clinical indications, a gynecological smear is taken from women in the following cases:
- complaints of heavy discharge from the genital tract;
- itching and burning in the labia area;
- pain in the lower abdomen and menstrual irregularities associated with inflammatory processes of the genital organs;
- the presence of a sexually transmitted infection in a partner;
- infertility, etc.
2. Culture for gonorrhea
A special culture test to detect this disease.
In what cases is it prescribed:
- screening during pregnancy registration;
- if gonorrhea is suspected based on clinical indications or based on the results of a gynecological smear;
- when identifying sexually transmitted infections (trichomoniasis, chlamydia, syphilis, etc.);
- when gonorrhea is detected in a sexual partner.
3. Culture of flora with determination of sensitivity to antibiotics
This analysis allows you to identify conditionally pathogenic and pathogenic flora, determine its quantity, and also test for sensitivity to antibacterial drugs.
In what cases is it prescribed:
- when inflammation is detected in a gynecological smear, in the absence of treatment effect;
- during examination during pregnancy;
- before planned gynecological operations.
4. Smear for examination using the PCR method
The analysis helps to identify the genetic structure of the pathogen, which cannot be detected in a gynecological smear. These are infections such as chlamydia, mycoplasma, herpes simplex virus (HSV), human papillomavirus (HPV), etc.
In what cases is it prescribed? To clarify the type of pathogen in the inflammatory process, in order to prescribe specific therapy.
5. Femoflor screen
Allows you to maximally determine the microbial composition of vaginal secretions in one examination, identifying the main pathogens. This diagnosis includes the determination of the following microorganisms: lactobacilli, gardnerella, ureaplasma, candida, mycoplasma, trichomonas, HSV 1 and 2, gonorrhea, cytomegalovirus, chlamydia.
In terms of information content, this study combines both a gynecological smear for flora and a PCR examination. Requires special equipment, media and test systems, and is therefore not carried out on a large scale.
How to prepare for any of the flora examinations? The listed tests cannot be taken while taking antibiotics and antimicrobials. Sexual abstinence from 1 to 3 days is required, no douching, no use of spermicides and vaginal suppositories for at least 3 days.
Important! If you take control tests for infection, then they can be repeated only 10-14 days after the end of treatment - for simple gynecological smears and cultures for flora and gonorrhea, and for smears using the PCR method - only 1 month after taking the last antibiotic tablet.
KPI
Another group of examinations are smears to determine the hormonal function of the vaginal epithelium, or the karyopyknotic index (KPI).
The analysis allows you to determine the saturation of vaginal cells with estrogen. Necessary for determining ovarian function in women of reproductive age and the degree of hormonal deficiency during menopause.
Dear women! If something bothers you, don’t delay: see a doctor, get tested. But even if you have no complaints about women’s health, still find some time for yourself and see your gynecologist at least once a year. Your health is in your hands!
Examination in gynecology
You begin to be tormented by vague doubts that your hormonal levels are not in order: hair in the wrong places, irregular cycle, enlarged thyroid gland, weight changes, oily skin etc. I don’t want to think that this could be an age-related variant of the norm, a consequence of stress, the result of poor nutrition and lifestyle, or a hereditary trait. I would like to find the culprit - the wrong hormone - and fight it with a pill. Take a pill and forget your problems. Of course, this is much easier than sticking to a diet or exercising or regularly visiting a cosmetologist, etc. The hormones tested are those that are made in the nearest accessible laboratory - some random set of indicators without taking into account the day of the cycle and daily biorhythms. If a hormone test turns out to be normal, bewilderment arises - what’s the matter then? The questions begin in the series “I checked everything - everything is fine, what should I do?”
In fact, all tests require clear indications. For each clinical situation there is a specific examination plan, which includes a set of tests - in in a certain order, subject to certain conditions. Only then will the results of these tests really help your attending physician, otherwise he will put aside all the papers you brought and write new list, and you will worry about lost time, money and blood (in the literal sense of the word).
In addition, during the course of his work, each doctor, receiving test results done in different laboratories and comparing them with what he sees - with complaints, with treatment results - draws a conclusion about the reliability of some laboratories. And about the unreliability of most others. Naturally, a real doctor cannot prescribe treatment based on unreliable tests and treat who knows what. And precisely because the attending physician, and not the laboratory, is responsible for the patient’s health, a decent attending physician refers to those laboratories whose results he trusts. Of course, it can be difficult to distinguish this motive from a simple desire to make money from tests, and here the question arises about personal trust in the attending physician. And if you trust him, know that such behavior is often in your interests. Therefore, it is always better not to wander around laboratories and take tests yourself, and then come to the doctor with a stack of papers; and first find your attending physician, who will already write a list of tests that he considers necessary, and a list of laboratories where he advises taking these tests. The examination algorithms given below are given as a guide, for the concept of what needs to be done in a given situation, so that you know where to run if you don’t have a doctor yet and no one really tells you anything. But no algorithm is a dogma and cannot take precedence over the individual prescriptions of a personal physician.
And of course, this is just an examination algorithm, and not a guide to self-diagnosis and self-medication. Only a doctor can interpret all the tests obtained.
So, the examination algorithms required in the following situations:
I just want to get tested for hormones(determination of hormonal status)
1. On days 5-7 of the cycle (day 1 of menstruation - day 1 of the cycle) the following hormones: LH, FSH, estradiol, prolactin, testosterone, DHEA-S, DHEA, cortisol, 17-hydroxyprogesterone, TSH and free T4.
Stress hormones: prolactin, cortisol, LH - may be increased not due to hormonal diseases, but due to chronic or acute (going to the hospital and donating blood from a vein) stress. They need to be retaken. To diagnose hyperprolactinemia, for example, three elevated prolactin levels are measured.
2. Progesterone It makes sense to take it only in the middle of the second phase of the menstrual cycle. After 3-5 days of stable rise basal temperature, with an ultrasound picture of the second phase (corpus luteum in the ovary and mature endometrium), you can donate progesterone (with a regular 28-30 day cycle - on days 20-23).
All hormones are taken strictly on an empty stomach, as are any blood tests.
If it is not possible to take the necessary hormones on the right days of the cycle, it is better not to take them at all than to take them on other days of the cycle. The analysis will be completely uninformative.
Delayed menstruation
1. Home pregnancy test
In the morning urine sample, it is indicative only from the first day of delay. False negative results are more common than false positives.
If negative:
2. Ultrasound with a vaginal sensor
If the ultrasound picture of the mature second phase of the cycle (thick mature endometrium, corpus luteum in the ovary):
3. Blood for beta-hCG
If negative- wait for your period, it will come soon.
If in doubt- retake after 48 hours. With developing intrauterine pregnancy the figure will double.
If there is no picture of the second phase on the ultrasound, then this is not pregnancy, and it is far from menstruation. This is ovarian dysfunction, you need to go to a gynecologist and figure it out - whether to wait or help with vitamins, herbs, hormones, etc.
If a home pregnancy test is positive, an ultrasound with a vaginal probe still needs to be done to understand the location of the pregnancy (uterine or extra-uterine) and its viability (there is a heartbeat or not). When the test is positive, pregnancy is always visible on an ultrasound with a vaginal probe. Heartbeat is visible from 5 weeks (from 1 day of the last menstruation with a regular cycle). Frequent ultrasounds at any stage of pregnancy, including early ones, are absolutely harmless. Much more dangerous are the extra days spent with an undiagnosed ectopic or frozen pregnancy.
Absence of menstruation for several months, irregular cycle
2. After excluding pregnancy - determination of hormonal status ()
3. Computer or magnetic resonance imaging of the sella turcica (exclusion of pituitary tumor)
Selection of hormonal contraception
1. Biochemical blood test with an emphasis on the lipid spectrum (total cholesterol, HDL, LDL, VLDL, triglycerides), fasting glucose, liver parameters (total bilirubin, direct bilirubin, total protein, albumin, ALT, AST, gammaGT)
2. Hemostasiogram and coagulogram (blood coagulation parameters: fibrinogen, prothrombin index, APTT, AVR, thrombotic potential index, level of platelet aggregation, fibrin degradation products.)
3. Ultrasound of the pelvic organs 2 times per cycle - after menstruation and before the next menstruation. Assessment of follicle growth, endometrium, presence of ovulation, formation of the corpus luteum and endometrial maturation. Exception possible diseases pelvis, diagnosed by ultrasound. Only with a vaginal sensor.
5. Examination by a therapist, control blood pressure and the condition of the veins.
Preparing for a planned pregnancy(first or subsequent)
0. Spermogram. Desirable, although not required at the beginning of planning. This is done not so much to assess the ability to bear children, but to determine the quality of sperm (the number of pathological forms, for example) and to identify a hidden inflammatory process (a much more informative analysis than any smears and PCR).
1. A trip to the dentist, therapist, ENT specialist (treatment chronic tonsillitis- very important!)
2. Examination by a gynecologist, colposcopy
3. Blood type, Rh factor for both spouses
If a woman has a positive Rh factor, there are no problems.
If a woman has a negative Rh factor, antibodies to the Rh factor (even if the man is also negative).
If they are positive, pregnancy is currently impossible and needs to be corrected.
If negative, repeat this test once a month, starting at 8 weeks of pregnancy.
If a woman has group 1, and a man has any other, there may be incompatibility in blood groups. An analysis for group antibodies, as well as an analysis for antibodies to the Rh factor, is carried out once a month, starting from 8 weeks of pregnancy.
4. TORCH complex. Antibodies to rubella, toxoplasma, herpes, CMV, chlamydia - quantitative analysis (with titer). The presence of IgG antibodies means immunity to these infections and is not an obstacle to pregnancy. The presence of IgM indicates an acute stage; planning in this case must be postponed until recovery. If there are no IgG antibodies to rubella, you need to get vaccinated and then protect yourself for another 3 months. Do not ask your parents if you have had rubella; it is impossible to know for sure - it can occur under the guise of an acute respiratory infection and vice versa. Only a blood test for antibodies can provide accurate information.
5. Tests for infections: regular smear, PCR for latent infections - for both.
7. Basal temperature chart. From 6 to 8 am, at the same time, without getting out of bed, mercury thermometer 5 minutes in the rectum. All deviations from this regime and special circumstances (medications, ailments, sleep disorders, menstruation, sex life, stool disorders, etc.) - noted in a special column.
8. Hormones - adrenal androgens and characterizing the state of the thyroid gland. DHEA sulfate, 17-hydroxyprogesterone, TSH, free T4, antibodies to thyroid peroxidase. Any day of the cycle.
9. Hemostasiogram, coagulogram ()
10. Determination of lupus anticoagulant, antibodies to human chorionic gonadotropin, antibodies to phospholipids - factors of early miscarriage.
11. General clinical analysis blood (hemoglobin, erythrocytes, leukocytes, platelets, ESR, color index, leukocyte formula). Blood from a finger.
12. General analysis urine (the morning portion of urine is completely collected, and it is important that the analysis does not include secretions from neighboring organs).
Pregnancy
From the moment of establishment (test, blood test), then once a trimester is mandatory, once every 4-6 weeks is desirable, in case of violations - 2 weeks after the correction.
1. Ultrasound. Establishment of a uterine developing (heartbeat +) pregnancy. Monitoring development, compliance with deadlines, exclusion of developmental defects, placental insufficiency, threat of miscarriage. After 8 weeks - with a regular sensor. Not harmful.
2. General clinical blood test ()
4. Urinalysis according to Nechiporenko, if there are doubts about the general analysis.
At the same time, the average portion of morning urine is collected in a jar.
6. Lupus anticoagulant, antibodies to phospholipids, to hCG.
7. Antibodies to rubella, toxoplasma (if not tested yet), herpes, CMV (in any case)
8. Antibodies to Rhesus and group antibodies in case of incompatibility, starting from 8 weeks.
9. Daily urine at 17-KS.
17-ketosteroids are metabolic products of male sex hormones. This analysis allows you to evaluate the total level of all male hormones per day. This is an advantage over individual hormone blood tests, which measure individual hormone levels over time and are thus less sensitive. Daily urine on 17-KS allows you to catch any fluctuations in any male hormones during the day. Although this analysis is older and less user-friendly, it is no less informative.
3 days before collection and on the day of collection, exclude from food coloring products(yellow, orange, red): carrots, beets, red apples, citrus fruits (all including juices, salads, sauces, soups, etc.), vitamins. Otherwise, the indicator will be overestimated.
On the day of collection, the first morning portion of urine is not collected. Next, all day, all night and the first morning portion next day(at the same time as the day before, i.e. so that exactly 24 hours pass between two morning servings) - collected in one large container. Next, the volume of daily urine is carefully measured with a measuring cup (the accuracy of the analysis depends on the accuracy of the volume) and written down on a piece of paper along with your full name. The contents of the container are mixed and poured into a small jar, like a regular urine test. The 17-KS level will be recalculated to the total daily volume indicated on the piece of paper.
If this is available in your laboratory, blood test for DHEA-S and 17-hydroxyprogesterone.
10. Tests for infections - smear and PCR (cm)
11. TTG, St. T4, antibodies to TPO - thyroid condition.
At 15-16 weeks additionally:
1. Markers of some defects and placental insufficiency: AFP (alpha-fetoprotein), free estriol, beta-hCG and 17-hydroxyprogesterone.
The analyzes are interpreted together with each other and with ultrasound data; real deviations are changes several times compared to the norm. The significance of these parameters is indirect. In case of unfavorable and questionable indicators + the presence of risk factors (age, genetics, medical history, etc.), according to indications - amniocentesis or cordocentesis - collection of fetal cells for chromosomal analysis. This is the same study for precise definition floor.
2. Ultrasound with a vaginal sensor to determine the length of the closed part of the cervix - diagnosis of isthmic-cervical insufficiency.
In the second and third trimester
If there are signs of possible placental insufficiency, intrauterine fetal development retardation, according to indications - Doppler ultrasound (a type of ultrasound with determination of the degree of blood flow).
From 33 weeks
CTG (cardiotocography) - determining the condition of the fetus by analyzing its cardiac activity and motor activity. The only study that allows us to determine the condition of the fetus, and not the mother’s body. You should not come to CTG on an empty stomach, but in a normal, well-fed and alert state, because while the child is sleeping, the indicators will be underestimated, and the examination time will have to be extended (normally 40-60 minutes).
Examination after a frozen or interrupted pregnancy
2. Ultrasound of the pelvic organs with a vaginal sensor ()
3. Measuring basal temperature ()
4. Determination of hormonal status ()
5. Hemostasiogram, coagulogram ()
6. Determination of lupus anticoagulant, antibodies to human chorionic gonadotropin, antibodies to phospholipids.
8. Tests for infections: regular smear, PCR for latent infections. (cm)
9. Hysterosalpingography - checking the patency of the fallopian tubes.
It is done on days 18-21 of the regular menstrual cycle (in the middle of the second phase). The entire cycle in which HSG is performed, from the very beginning, must be strictly protected and not hope that since nothing has worked so far, it will not work in the future. X-ray of the uterus early stages pregnancy is an absolute indication for its termination. Three days before the HSG, you need to prepare for it - no-shpa, valerian; Do an enema the day before, and have a light breakfast in the morning. Prepare for sensations like during menstruation.
10. Determination of antisperm antibodies in semen (MAR test), cervical fluid (during ovulation), if necessary - in blood, postcoital test.
11. Laparoscopy. To exclude endometriosis, accurately check tubal patency, diagnose unexplained infertility - a combination of diagnosis and treatment. It is better to do it in the first phase of the cycle. General anesthesia.
Chronic itching of the genitals1. Gram smear for flora
2. Bacteriological study - culture with determination of sensitivity to antibiotics
4. Determination of markers of hepatitis, HIV infection, syphilis (RV, HIV, HbSAg, anti-HCV)
If not:
6. Taking an anamnesis - itching in other parts of the body, skin itching (lymphomas, multiple myeloma, diabetes, pathology of the thyroid gland, scabies, neurodermatitis, urticaria, pathology of the gastrointestinal tract, liver, kidneys, drug effects, drugs), what means help
7. General clinical blood test (anemia, blood diseases, allergies, helminthic infestation)
8. Determination of glucose in fasting blood (blood for sugar)
9. General urine test (infection, sugar, salts)
10. Examination by a gynecologist and dermatovenerologist, scraping and microscopy ( contact dermatitis, scabies, lice, urticaria, lichen planus, trauma/, herpes, papillomas, mycoses)
2. Detailed biochemical blood test ()
3. General clinical blood test ()
4. Analysis of hair for mineral composition
Overweight or underweight
1. Determination of hormonal status ()
2. Biochemical blood test with an emphasis on the lipid spectrum (total cholesterol, HDL, LDL, VLDL, triglycerides), fasting glucose, liver parameters (total bilirubin, direct, total protein, albumin, ALT, AST, gammaGT), and also conduct a test on glucose tolerance.
Checking your thyroid condition(unfavorable heredity, suspicion of thyroid pathology, abnormalities in TSH and free T4 tests)
1. Retest the hormones TSH, free T4 and free T3
2. Antibodies to thyroid peroxidase and thyroglobulin
3. Ultrasound of the thyroid gland.
(The most important of these tests is the first one. If the hormonal function of the thyroid gland is not impaired, the mere presence of antibodies or ultrasound signs of thyroiditis are not indications for treatment).
Pain, engorgement, thickening of the mammary glands, nipple discharge
1. Ultrasound of the mammary glands (if you are under 35 years old) or mammography, if older.
2. Determination of hormonal status ()
3. If prolactin levels are repeatedly elevated, computed tomography (or better yet, magnetic resonance imaging) of the skull (sella turcica area) to exclude pituitary pathology. X-ray of the sella turcica is not very informative and cannot replace MRI.
4. Consultation with a mammologist
Climax- soon or already, selection of menopause replacement therapy, monitoring its effectiveness
1. Determination of hormonal status (). The test for menopause is an increase in FSH levels
2. Biochemical blood test with an emphasis on the lipid spectrum (total cholesterol, HDL, LDL, VLDL, triglycerides), fasting glucose, liver parameters (total bilirubin, direct, total protein, albumin, ALT, AST, gammaGT) and kidney parameters (urea, residual nitrogen, creatinine).
3. Glucose tolerance test.
4. Ultrasound of the pelvic organs with a vaginal sensor ().
5. Examination by a therapist, blood pressure control.
6. General clinical blood test ()
7. Hemostasiogram and coagulogram ()
8. Mammography
9. Screening for osteoporosis:
Two-photon densitometry or dual-energy X-ray absortiometry.
Determination of markers of bone remodeling in the blood: hydroxyproline, pyridinoline, deoxypyridinoline, N-telo-peptide-NTX, bone isoenzyme alkaline phosphatase, osteocalcin.
Determination of calcium and phosphorus levels in the blood is not informative, as is bone x-ray.
Endometriosis
1. Ultrasound with a vaginal sensor on the eve of menstruation. This is how endometrioid ovarian cysts and internal endometriosis of the uterus (adenomyosis) are diagnosed. For differential diagnosis with other ovarian cysts, a repeat ultrasound is necessary.
2. Hysteroscopy - to confirm adenomyosis.
3. Laparoscopy - for diagnosis (and immediate treatment) of external genital endometriosis of the peritoneum.
Ovarian cysts, tumors, formations
1. Repeated ultrasound. Functional cysts go away on their own within 3-4 months.
2. Tumor markers (CA-125, CA-19, etc.). The analysis is non-specific; only a sharp increase in indicators by several times is significant. They will also be elevated with functional ovarian cysts.
3. Determination of hormonal status ().
The last point in all algorithms is consultation with the attending physician and his interpretation of the results obtained. Further examination and treatment tactics depend on the results of the basic algorithm.
A woman’s health and well-being consists of many components. A woman is a hormonally dependent creature, i.e. the normal activity of the reproductive system is based on the refined work of the endocrine glands. In addition, the microflora of the body, including the biocenosis of the vagina, significantly affects the girl’s quality of life.
Imbalances in the healthy vaginal microflora not only lead to painful symptoms that significantly reduce the daily activity of the fair sex, but also lead to the development of various gynecological diseases. And this, in turn, is a formidable risk factor for infertility.
Tests in gynecology
Gynecology is a very subtle and delicate science, so there are a very large number of diagnostic methods. One of the simplest and most cost-effective diagnostic methods that are carried out in any antenatal clinic or gynecological hospitals are various smears on the flora.
There are several types of flora smears:
- Bacterioscopic analysis or microscopic examination (direct smear on the flora).
- Cytological analysis - to detect atypical cells for this location (PAP test).
- Bacteriology or bacterial culture to identify pathological flora.
All smears are carried out after a special gynecological examination, which includes examination of the external genitalia, palpation of the uterus, and examination of the cervix in the speculum.
Many women ask the question: “When exactly can you get tested, and on what day of the menstrual cycle should this be done?” There are no strict restrictions in this matter. However, gynecologists recommend taking smears at the beginning of the menstrual cycle, immediately a few days after menstruation. You can also take a smear just before your period.
Preparing for analysis
Any woman should remember that any diagnostic procedure must be preceded by certain preparation. It is carried out in order to avoid false results, which may prompt the doctor to make an incorrect diagnosis and prescribe inappropriate treatment.
Preparation for taking a vaginal smear (rule of twos) includes:
- Two days before the examination you need to abstain from sexual intercourse.
- Stop taking antibiotics two weeks before.
- Stop taking it 2 days before hormonal drugs and administration of vaginal suppositories and creams.
- It is not recommended to urinate 2 hours before the procedure.
After deciphering the results, it is possible that the results will be bad. In this case, a repeat vaginal smear is taken.
Smear microscopy
Bacterioscopic analysis is one of the most informative in the diagnosis of gynecological pathologies. This method has a fairly impressive list of indications:
- The presence of subjective discomfort in the perineal area in a woman (itching, burning, unpleasant odor, etc.).
- Complaints of pain in the lower abdomen.
- The presence of pathological discharge (profuse mucous, mixed with blood or pus, leucorrhoea with an unpleasant putrefactive odor).
- Annual preventive examinations.
- Advance pregnancy planning.
- The immediate period of bearing a child.
- When changing sexual partner.
A smear for flora is taken from several locations: vagina, urethra or the urethra, the cervical canal and sometimes, if there are special indications, from the rectum.
What can a smear test reveal? A vaginal smear provides the doctor and patient with detailed information about the state of microcinosis in the intimate area. The smear shows:
- The number of leukocytes in the cervical mucus.
- The number of leukocytes in the cervical area.
- Presence and number of red blood cells.
- Epithelial cells and their number.
- Character of mucus.
- Bacteria, including “good” ones - lactobacilli, their composition and quantity.
- The presence and quantity of pathological microorganisms - Trichomonas, gonococci, fungi, etc.
The procedure is non-traumatic and painless. Healthy women are recommended to undergo bacterioscopy of vaginal discharge once every 6 months.
Norm
Each of the above indicators has its own limits, deviations from which (usually upward) are considered to be the development of some inflammatory or infectious pathology. It is worth keeping in mind that the norm of indicators healthy woman reproductive age, teenage girls and women in menopause may have some variability. There are also individual norms for vaginal discharge in pregnant women.
So, let’s look at the norm for each of the indicators during microscopy of vaginal discharge.
Leukocytes. These are so-called white blood cells. They act as immune defenders of our body from any external infectious agents. Normally, single leukocytes are present in the cervical canal and on the cervix. But if, when deciphering the smear analysis, an increase in the number of leukocytes is observed, then this indicates the beginning of the development of the inflammatory process in the vagina.
The norm varies depending on the location:
Sometimes the white blood cell count in the vagina and cervix can be 100 cells per field of view or higher. This indicates an acute stage of inflammatory pathology.
Epithelium. Normally, single epithelial cells are present in vaginal discharge. The normal number of these cells is up to 15 in the laboratory technician’s field of view. In vaginal discharge, squamous epithelium is determined at all stages of its development. And in a smear from the cervical canal and on the surface of the cervix, columnar epithelium is found. The difference in epithelial cells depending on the location is due to the different cellular structure of the walls of the vagina and cervix. An increase in epithelial cells may indicate the presence of chronic inflammatory disease(often with a latent asymptomatic course).
Mucus. Normally, this substance is absent in the urethra, but is present in the vaginal cavity. Depending on the period of the menstrual cycle, the volume of mucus can vary from scanty to abundant. When pregnant women secrete a large amount of mucus, a high glycogen content is also found in it. Glycogen is a special protein that is a nutrient medium for lactobacilli.
Microorganisms. In women of reproductive age, including during pregnancy, microscopy of vaginal discharge reveals gram-positive flora. These are lactobacilli - cells that provide normal microcinosis of the vagina. In postmenopausal women and girls before menarche (their first period), little or no lactobacilli are detected. A sharp decrease in these cells indicates bakvaginosis. Predominantly in these age categories the presence of coccal flora is observed.
In addition to lactobacilli, microscopy can also detect pathological bacterial flora - Trichomonas, gonococci, gardnerella. Normally, in healthy women and during pregnancy, these cells are completely absent. Their detection indicates the presence of a sexually transmitted disease.
In addition to bacteria, fungi of the genus Candida can be detected. Their presence in vaginal discharge indicates carriage or the development of a disease such as thrush.
Smear in pregnant women
As mentioned above, some indicators during pregnancy may differ from the norm in non-pregnant women. A smear for flora during pregnancy is taken three times:
- During pregnancy registration (up to 12 weeks).
- At 30 weeks.
- Immediately before birth, in the last week of pregnancy.
The main difference in smear analysis when deciphering it is that during pregnancy there are a larger number of lactobacilli. In addition, during pregnancy there is a larger volume of mucus enriched with glycogen.
Let's summarize and compare the indicators of a healthy woman of reproductive age and a woman during pregnancy.
In addition to these indicators, the smear may reveal the presence of cells atypical for a given location. The so-called ugly cells are called atypical, i.e. these are cells with dramatically changed shape, size and structure. As a rule, they are detected by scraping from the surface of the cervix. The presence of this indicator indicates incipient uterine dysplasia. Dysplasia is a precancerous disease that is characterized by cellular and tissue restructuring of the organ. In this case, a more extensive study is required and a cytology smear is required.
Gynecologists currently take no more than one day to decipher tests. The results are calculated using a special apparatus or manually. A vaginal smear gives a detailed picture of the state of a woman’s reproductive system, including during pregnancy. Microscopy of secretions for flora is a low-cost diagnostic method, widespread and accessible to every woman.