SPECIAL DIAGNOSTIC TESTS IN MIDWIFERY

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Monday, January 18, 2021First year M.Sc.Nursing 1

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SPECIAL DIAGNOSTIC TESTS IN
OBSTRETICS AND GYNECOLOGY
By
Mrs.Jasmi Manu
Head of the department(OBS/GYN) Nursing
Rama college of Nursing
Rama University, Kanpur

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INTRODUCTION
• ‘’YOU CAN TELL THE CONDITON OF A NATION
BY LOOKING AT THE STATUS OF IT’S WOMEN’’
(JAWAHARLAL NEHRU)

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• For the better health of the women,the early detection of
the disease is compulsory.
• keepping up of health of the mother and child ,they have to
be screened ,properly treated, nourished and cared.
• For the prevention of all possible complications during
antenatal, intranatal, and postnatal periods many new
technologies and techniques are formed
• .As we are the post graduate nurses in –OBSTETRICS AND
GYNAECOLOGY-It’s our prime objective to know the need,
utility, and contributionsof advanced technologies in
obstetrics and gynaecology in the prevention of maternal
and child mortality and morbidity

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IMPORTANCE OF DIAGNOSTIC TEST
IN OBS-GYN:-
• To know that any variations in the normal
pregnancy
• To find out the abnormal problems in it’s early
stage of pregnancy
• To prevent complication
• Help for the safe delivery and healthy
newborn
• To rule out all the gynecological problems in
women

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RECENT TECHNOLOGIES IN THE HEALTH
CARE DELIVERY SYSTEM IN OBSTETRICS
AND GYNECOLOGY:-
• Having a baby today in this country is a
relatively not a safe event ,there may be
serious complications and problems for
mother and child………………Modern obstetrics
has improved the lives of countless mothers
and babies over the past 32 years…..New
technologies have come in the
assessment,diagnosis, and treatment

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ASSESSMENT
Majority(80%)of foetal deaths occur in the
antepartum period .The important causes of
death are
• 1.chronic foetal hypoxia(IUGR)
• 2.Maternal complications such as Diabetes,
hypertension ,infection etc….
• 3.Foetal congenital malformation
• 4.unexplained causes

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ASSESSMENT OF HIGH RISK
PREGNANCIES
• High risk pregnancies one in which a
concurrent disorder , Approximately 3% of
live born infants have major congenital
anomaly.Which are responsible by the Genetic
factors..About 50% of first trimester
spontaneous abortions and 5% of still born
infants have chromosomal abnormalities….
Approaches for improving women’s health by
newer modalities of diagnosis have come in
action

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1 BIOPHYSICAL ASSESSMENT:-
• Bio physical profile is a screening test for
utero –placental insufficiency.The foetal
biophysical activities are initiated,modulated
and regulated through foetal nervous
system.The foetal CNS is very much sensitive
to diminished oxygenation

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• Hypoxia/Metabolic acidosis/CNS depression
• Changes in the foetal biophysical activity
• As these tests are said to be the Dynamic tests
of foetal well being ….It tell us about the
behaviour of the foetus in utero and help the
observer to differentiate between a healthy
but ‘at risk’ baby and a baby suffering from
anoxia ….

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THE FOLLOWING BIOPHYSICAL TEST ARE
OF USE:-
• Daily foetal movement count(DFMC)
• Non stress test(NST)
• Unstressed cardiotocography (CTG)
• Oxytocin challange test(OCT)

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DAILY FOETAL MOVEMENT COUNT(DFMC)
• 88% of the fetal movements are detected by Doppler
imaging
• The count should be performed daily starting at28
week of pregnancy.
• Three counting ,each of one hour duration
(morning, noon, and evening)are recommended
• .The total counts multiplied by 4 gives daily
(12hour)fetal movement count……if there is any
diminution of the number of ‘kicks’ to less than 10 in
12hours,it indicates a failing placental function…
• It is a useful method of fetal health .Loss of fetal
movements is commonly followed by disappearance
of F.H.R within the next 24hours

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• In non stress test, a continous electronic
monitoring of the fetal heart rate along with
recording of fetal movements
(cardiotocography) is undertaken. There is an
observed association of FHR acceleration with
fetal movements, which indicates a healthy
foetus. The testing should be started after
30weeks of pregnancy .Frequency will be
twice a week…

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Cont……………….
• The accelerations of the FHR associated with
fetal movements are presumably reflex
mediated.
• It takes into account the overall utero
placental function on the central nervous
systemof the foetus .
• Apart from fetal hypoxia,depression of FHR
associated with fetal movements is observed
in fetal acidosis and when narcotic drugs are
used by the mother

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FETAL CARDIOTOCOGRAPHY(CTG):-

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• A normal tracing of heart rates of the foetus after 32
weeks,indicated.
• FHR also related to uterine activity
• .A normal tracing shows a baseline rate of 120-160
beats per minute with a baseline variation of more
than 5 beats per minute.
• If there is late and variable deceleration of FHR in
response to uterine contractions,it indicates
substantial fetal hypoxia.
• The result is also affected by pethidine or diazepam
drugs to the mother……….

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• It is an invasive procedure to assess the fetal
well being in utero during pregnancy as
suggested by alteration in FHR in response to
uterine contractions.
Oxytocin challenge test

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• Procedure:-The oxytocin infusion is started in
the initial rate of infusion is 1Mu/min which is
stepped up at intervals of 15 min until the
effective uterine contractions are established
.The alteration of the FHR during contractions
can be interpreted by electronic cardio
tocographic equipment fitted to the patient’s
abdomen.

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BIO CHEMICAL ASSESSMENTS-
• Maternal serum alpha protein---
• Coomb’s test---
• Chorionic villus sampling
• Fetal sampling:-Cordocynthesis
• Amniocetesis:-

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Maternal serum alpha protein
• Done in 14th week of pregnancy to detect neural
tube defect in the foetus.
• Chromosome analysis of amniotic fluid cells and
amniotic fluid alpha -feto protein determinations
were used to investigate a fetuses with severe
intrauterine growth retardination in the third
trimester

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Coomb’s test---
• used to check Rh incompatibility if the maternal
titter for Rh antibodies is greater than 1;8 indicative
of other tests to detect fetal anemia from hemolysis

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Chorionic villus sampling :-
• it is performed for prenatal diagnosis of genetic
disorders..
• Done under ultrasound guidance where by small
amount of chorioinic tissue is obtained for fetal
karyotyping

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Fetal sampling:-Cordocenthesis
• (percutaneous umbilical blood sampling )
• done in14 weeks of gestation to detect
congenital anomalies in the foetus and fotal
cells in maternal circulation

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Amniocetesis:-
• amniocetsis is the deliberate puncture of the
amniotic fluid sac per abdomen
 Indication
– Diagnostic
– Therapeutic

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• Diagnostic:-
• -early months(14-16)weeks antenatal diagnosisof
chromosomal and genetic disorders
– 1.sex linked disorders
– 2.karyotyping
– 3.in born errors of metabolism
– 4. neural tube defect
• -late months
– 1.foetal maturity
– 2.degree of fetal hemolysis inRh sensitized mothers
– 3.meconium staining of liquor-an evidence of fetal distress

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• THERAPEUTIC:-
• First half
• 1.induction abortion by instillation of chemicals such
as hypertonic saline, urea,or prostaglandins
2.repeated decompression of the uterus in acute
hydramnios
• Second half
• 1.decompression of uterus in unresponsive cases of
chronic hydramnios
• 2.to give intra uterine fetal transfusion in severe
hemolysis following Rh iso immunization

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PROCEDURE:-
• After emptying the bladder ;the patient
remains in dorsal position
• Abdominal wall is prepared asceptically and
drapped
• The proposed site of puncture is infiltrated
with the 2ml of lignocaine

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• SITE FOR BLIND PROCEDURE:-
• In early months;-1/3rd of the way up the uterus from
symphysis pubis
• In later months;-trans isthmic supra pubic approach
…..After lifting the presenting part or through the
flanks in between the fetal limbs or below the
umbilicus behind the neck of the foetus

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• At 18-20 gauge spinal needle about 4’’ in length is
pierced in to the amniotic cavity under real time
sonographic control with the styllete .The styllete is
withdrawn and few drops of liquor are
discarded…….About 30 ml of fluid is collected in test
tube for diagnostic purpose
• PRECAUTION:-prophylactic administration of 100 mg
of anti D immunoglobulin in Rh- negative non
immunized mothers

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HAZARDS
• MATERNAL:-Infection, haemorrhage,
premature rupture of membrane and preterm
labour, maternal iso immunization of Rh-
negative cases
• FETAL:- Abortion, trauma, feto maternal
haemorrhage, oligo hydramnios that lead to
fetal lung hypoxia, hypoplasia ,respiratory
distress, talipes

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EXAMINATION OF THE URINE
• Collect the 1, 2,3, first morning sample in a
clean container .clean catch midstream urine
has to be collected

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• A) TEST FOR PROTEIN
1. QUALITATIVE
2. QUANTITATIVE
1. QUALITATIVE
– HEAT AND ACETIC ACID TEST
– DIPSTICKS

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Heat and acetic acid test:-
Experiment:-
Three-fourth of a test tube is filled
with urine, tube is held obliquely
and the upper part of the urine is
heated
Add few drops of 5%acetic acid to it
Observation:-
A cloudy precipitate is formed
The cloudiness persists or increase
Interference:-
Presence of protein or
phosphate
Presence of protein
REPORT:-PROTEIN-absent, trace(+),(++)or (+++)

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DIPSTICKS(AIBU STICX):-
• Procedure:-The strip is dipped in to the urine
and takes it out immediately. Compare the
colour changes in the stick with colour chart
.If the test and turns green blue the test is
positive

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B) TEST FOR SUGAR
• BENEDICT’S TEST
• DIPSTICK’S DIATIX

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BENEDICT’STEST
• Procedure:-5 ml of Benedict’s reagent is
taken in a tube and is heated to boiling
• Add 8-10 drops of urine to it
• Boil the mixture vigorously for 2mts and
allow it cool

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• RESULTS:- Presence of reducing substance is
indicated by the change of colour in the
precipitate

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DIPSTICK’S DIATIX
• PROCEDURE:-
~Dip the test tube end of the reagent strip in
urine and take it out immediately
~Observe the colour of the test end exactly one
minute
~ If there is change in colour of test end the test
is positive

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C) TEST FOR ACETONE
• ROTHERA’S TEST
• KETOSTIX

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ROTHERA’S TEST
• PROCEDURE;- Take 5 ml of urine in a test tube .Add
ammonium sulphate to make it saturated .Mix 3-4
drops of freshly prepared sodium nitro prusside
solution (or a few crystals of sodium nitro
prusside).Then over day with 1 ml of concentrated
ammonium hydroxide and allow to stand for 1-2
minutes

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• OBSERVATION:- A reddish purple ring is
appears at the junction of the two liquids ( a
brown ring is o f no significance)
• RESULTS:-Presence of acetone

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KETOSTIX
• The reagent strip dip in to the fresh specimen
.Compare the colour with given manufactor

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TEST FOR BLOOD COAGULATION
DISORDERS:-
• PROTHOMBIN TIME-Quick prothombin time
assay measures the time required for clotting
by extrinsic pathway and is carried out by
adding tissue thromboblastin to plasma.
Normal value is 11-17 sec .In a coagulation
failure ,the time is prolonged
• ESTIMATION OF FIBRINOGEN-Blood sample
has to be collected in EDTA bulb .If the value is
above 100 mg%,it is in the critical level

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• PLATELETS-Platelets is below 70000/cmm is
usually found in DIC
• FIBRIN DEGRADATION PRODUCT (FDP) ;- It is
estimated by latest agglutination test .In
normal pregnancy it is usually absent .In DIC
It is presence to an extent of 80mg/ml is
significant

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SAMPLES FOR BLOOD SUGAR
ESTIMATION
• 1.Glucose Tolerance Test
• 2.DEXTROSTIX

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Glucose Tolerance Test:-
• PROCEDURE- Patient should be on normal CHO diet for three
days prior to the test .Patient should not eat after dinner
and no breakfast is given. In the morning urine is collected
before commencement of the test
• A fasting venous blood sample is taken and then patient is
given 100gm of glucose in 250 ml of water flavoured with
lemon or orange. Further venous sample is collected at half
hours intervals for 3 hrs.

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• The patient should be at rest during the
period . Urinary samples are taken at 1hr,2 hr,
and 3hr . The concentration of glucose in
plasma or serum is typically about 15%
greater than that in whole blood

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2.DEXTROSTIX:-
• These reagent strip provide a rapid convenient
,specific and semi –quantitative method for
approximately blood sugar level .The strip is
composed of firm plastic ;one end of which is
impregnated with chromogen system which turns in
to oxidized chromogen ,based on the action of the
enzyme ,glucose oxidase

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• PROCEDURE:- Dip the entire test end of the reagent
strip in a large drop of blood either from finger tips
or ear lobule. Just after 60 sec wash off the blood
quickly with a sharp stream of water or to wipe off
the blood with a tissue .Read the results with in 1.2
sec after washing ,by comparing with the colour
chart supplied by the manufactor . The results are
provided directly in 1mg of glucose per 100 ml of
blood

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cervical and vaginal cytology
• Cervical cytology is done as a routine to every
women attending the antenatal clinic in advanced
countries;it’s selectively used in the developing
countries
• Indication:-
-Cervical -suspected cervix to exclude pre malignant
or malignant lesion
-Vaginal:-vaginitis –to know the specific pathogen
-Cytochromosomal study to know the progesterone
status

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Radiology in obstretics
• Currently there are rare conditions may help
during pregnancy
Principles of radiation in obstretics
• Benefits of radiation must out weigh the risk
of procedure
• Minimum radiation close to be used
• Appropriate fetal sheilding should be done
• First trimester should be avoided

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Maternal indication
• Patient having cardiopulmonary disease
• X-ray pelvimetry is of limited value in
assessing CPD

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Radiation hazards
• Teratogenesis
• Increased incidence of malignancy
• Gonadal irradiation

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CT-SCAN
(COMPUTERISED TOMOGRAPHY)
• It is a radiological technique that images soft
tissue. This is utilized in
• -spread of genital carcinoma
• -retro peritoneal lymph node metastasis
• -obstructive uropathi
• -metastasis in liver, .lungs,. and bones
• -pelvic abscess

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MRI(magnetic resonance imaging)
• Is more accurate assessment of bony pelvis….
• It is also helpful to assess the fetal size and
maternal soft tissue which are involved in
dystocia………
• it has no radiation risk……
• expensive, require more time and availability
is less

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ULTRASOUND IN OBSTETRICS
• -it is a sound wave beyond the audible range of
frequency greater than 2MHz
• -introduced by Ian Donald in glassgow in 1958
• -the commonly used frequency range in obstetrics is
3-5 MHz and 5-7 MHz for vaginal transducers
• -in medical imaging the transducer both sends and
receives ultrasound waves
• -in clinical practice standard ultrasound images are:-
• 1.B-mode ( brightness mode display)
• 2.M-mode used to moving organs

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DOPPLER ULTRASOUND
• -it is based on the principle of Doppler
frequency shift which means there is change
in frequency and wavelength between the
incident wave and reflected wave. when the
wave interacts with a moving structure (RBC in
umbilical artery).the Doppler shifted audible
signals can be converted to visual signals and
known as flow velocity waveform

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SPECIAL DIAGNOSTIC TEST CONDUCTED IN
GYNECOLOGY:-

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• ultrasonography
• vaginal examination
• cervical and vaginal smear
• cervical biopsy
• hysterosalphingeography
• colposcopy
• dilatation an curettage
• culdoscopy
• endoscopy
• Gynaecography
• Hysteroscopy
• Laparotomy
• PET

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ULTRASOUND:-
• It emits high frequency sound that is not audible with the
human ear
• The sound emits through a transducer received back by a
receiver
• The machine converts the echo reflected back and picturises
it thus image is created
• Types:-
1.transabdominal sonography
2.transvaginal sonography
3.transvaginal colour Doppler sonography

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• 1.TRANSABDOMINAL SONOGRAPHY(TAS):
It requires full bladder to replace the
bowel out of pelvis..operates at frequency of
2.5-3.5 MHz. best used for large masses like
fibroid or ovarian tumour

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• 2.TRANSVAGINAL SONOGRAPHY(TVS)
Done through the vagina. Bladder need no
to be filled .uses high frequency 5-8 MHz

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USES OF ULTRASOUND IN
GYNECOLOGY
• Uses in infertility
• Ectopic pregnancy
• Pelvic mass
• Oncology
• Endometrial disease
• Sonohysterography
• To locate the missing IUD
• Guiding the procedures

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PET
• (POSITRON EMISSION TEST)
• IT CAN MEASURE THE
difference between normal tissue
and cancerous tissue through glucose
analogue

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VAGINAL EXAMINATION
• Three types of examinations
1.speculum examination
2.digital examination
3. bimanual examination

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• 1SPECULUM EXAMINATION
-- It is done first before other examination
--sims and cuscos speculum are commonly used
--it used for inspection, collection of specimen from scrapings
• 2.DIGITAL EXAMINATION
--It is done with gloved finger with sterile lubricant jelly applied to it
-- palpation of bartholin gland ,cervix
-- integrity and tone of perineal body is noted
• 3.BIMANUAL EXAMINATION
--Used for palpation of uterus, palpation of uterine appenidgs, pouch of
douglas

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COLPOSCOPY:-
• DEFINITION:-Colposcopy is a diagnostic procedure by which
vaginal cervix is visualized through the optical instrument
which magnifies 10-14 times
• INDICATION:
– Detection of benign lesion
– Detection of sites of dysplasia ,carcinoma in situ ,pre-clinical and
early cancer of cervix and vagina
– Detection of recurrent lesion in cervix and vagina in follow up care
following surgery or radiotherapy for genital carcinoma
– Detection of carcinoma of cervix during pregnancy

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• PROCEDURE:-It’s an out patient procedure .Women
is placed in a lithotomy position with cervix and
vagina is exposed by the vaginal speculum. The
mucus is swabbed and vaginal cervix is painted with
3% acetic acid ,it cause swelling of the tissue and
coagulate the mucus. T hen the vagina/cervix is
viewed through colposcope

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NORMAL FINDING:-
• Pink normal squamous epithelium
• Grape like columnar epithelium
• Transformation zone with gland opening
ABNORMAL FINDING:-
• Suspect frank invasive carcinoma –atypical
vessel
• Inflammatory-plenty strawberry changes in
trichonomas infection

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ADVANTAGE:-
• It helps in localization of suspicious ca in its early stage
• It helps to avoid unnecessary biopsy and also taking biopsy
from a false place
• It can easy to distinguish cervical columnar cancer from
squamous cancer and also extend of cancer on the vagina
DISADVANTAGE;-
• It is more time consuming procedure
• It can miss pre-clinical cancer area
• Cannot detect the intra cervical lesion
• Need the availability of colposcope and trained person for
colposcopy

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GYNAECOGRAPHY
 Gynaecography is a x-ray demonstration of pelvis viscera
following introduction of pneumo peritoneum
 INDICATION
• Hirsuitism
• Amenorrhea
• Doubtful mass in the pelvis
• Double uterus, myoma
 CONTRAINDICATION
• Acute and sub acute pelvic cavity inflammation
• Large pelvic tumors to fill up the pelvis
• Cardiovascular or severe pulmonary disease
• Trans pneumo peritoneum is contraindicated when pregnancy is
suspected

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COMPLICATION:-
• Hematoma at the puncture site of the
abdominal wall
• Gas embolism
• Reflex-vaso vagal stimulation leading to
syncope
• Accidental puncture of bowel
• Shoulder pain, cough on sitting, and vomiting

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LAPROSCOPY
• Laparoscopy (peritonoscopy) is a endoscopic
visualization of the peritoneal cavity through
puncture of the anterior abdominal wall after
the induction of pnuemoperitonium .
• It is an intra-abdominal operation performed
through small incisions

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INDICATION:-
• Evaluation of infertile women by
• Detecting some pathology
• Evaluating tubal pathology
• Evaluating ovulation
• Pre-operative selection tuboplasty operations
• Post tuboplasty follow-up
• Diagnosis of pelvic lesion
• Evaluation of therapy response to endometriosis
• Investigations of amenorrhea, Hirsuitism
• Others uterine perfusions

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CONTRAINDICATION:-
• Severe cardiac or pulmonary disease
• Previous abdominal surgery
• Extreme obesity
• Acute pelvic inflammation

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COMPLICATION
• Anesthetic complication:-cardiac arrhythmias ,cardiac arrest,
• Complications of pnuemoperitonium:-surgical emphysema,
abdominal pain, gas embolism.
• Direct trauma:-to bowel, pelvic organs ,vessels
• Haemorrhage
• Infection:-abdominal wound ,pelvic infection
• Burns:-skin ,bowel and other organs
• Other complications:-pulmonary embolism ,omental
prolapse, chest
• pain

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CULDOSCOPY
• This is a vaginal route pelvic endoscopy
procedure alternative to laparoscopy
• DR.Albert deckers is the father of culdoscopy.

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• Procedure:-It is performed as an outpatient
procedure. Patient has to be fasting for 6-8 hrs prior
to the procedure …
• Inj.pethedine,inj.phenergan25mg, inj. Atropine IM
has to be given ½ hr prior to the procedure
• Pt has to be in knee chest position. Bladder
catheterization is done and cleaning the vagina with
swab is done. Posterior fornix is punctured and
throughout pnuemoperitonium ,through the whole
scope is inserted and visualization is done

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INDICATION:-
• DIAGNOSTIC
• OPERATIVE
– Diagnostic-----infertile women, chronic pelvic pain,
amenorrhea ,Hirsuitism
– Operative----tubal sterilization, can be done
LIMITATION:-Through this procedure upper abdomen
cannot be viewed
CONTRAINDICATION:-Pelvic inflammatory disease,
ruptured ectopic pregnancy
COMPLICATION:--
– -Rectal wall injury ,post operative shoulder pain ,pelvic
infection

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HYSTEROSCOPY
• endoscopic visualization of the uterine
endometrial sulcae and that of endocervix by
fibroptic hysteroscope passed through cervical
canal…….
• This was first practiced by GAUSS in 1928 and
Schroder in 1934 in GERMANY

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oPREPARATION-
• Bowel preparation to be done prior to the procedure. Fasting
• should be there prior to 8 hrs. Patient should be in lithotomy
position..
DIAGNOSTIC HYSTEROSCOPE:-
• It is 4mm telescope with sheath which has a channel for
gas or glycerin distension .Video endo carcinoma lens is fitted
to eye piece of hysteroscope and picture is projected to
colour monitor
OPERATIVE HYSTEROSCOPE:-
• Under general anesthesia cervix is dilated. Hysteroscope
with sheath and two channel is passed in to uterine cavity
…Through one channel distending fluid is introduced and
other channel laser fibre beamsare introduced

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CYTOLOGY IN GYNECOLOGY
• Cytology examination in gynecology is a
modern diagnostic procedure which become
useful in modern practice…..This procedure is
the study of cell either exfoliated or obtained
by scraping

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METHODS:-
• CYTOLOGICAL DIAGNOSIS OF GENITAL CANCER
Posterior vaginal fornix or vaginal pool aspiration:-
Patient is placed in the dorsal position and a glass pipette fitted with a
suction rubber bulb is introduced until its blunt end lies in the posterior
fornix .A drop of secretion is aspirated and expelled on a glass slide .The
slide is immediately immersed in equal parts of 95% alcohol and ether
while still wet and kept for 15mts for fixation o the smear
Cervical scrapping:-
• It is done by resolving ayre’s spatula for 360 degrees over the Porto
vaginalis after it has been exposed by cuscos speculum..This method is a
choice for detection of cervical lesion
Endo cervical or endometrial aspiration :-
• The content of the cervical or endometrial canal can be aspirated by
introducing a vacuum curette..Smear can be taken from material obtained
by uterine sound …Following fixation ,the slide is air dried and stained

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• CYTOHORMONAL DIAGNOSIS
• The lateral wall of the upper third of the vagina is lightly scraped by a
spatula or saline wet cotton swab
• SEX DETERMINATION
• Cytological study for sex chromatin is conveniently obtained by scraping
from the buccal mucosa .The mouth is rinsed with Saline..The inner
surface of the cheek is lightly scraped with edge of a tongue depressor and
the material is spread on the glass slide
• ASPIRATIION OF FLUIDS
• From ascitis, cysts, pleural fluids…This is collected in a bottle containing
equal quantity of 50% ethyl alcohol .Pap staining is performed detection of
cancer cells

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STAINED SMEARS ARE GRADED
INTO THE FOLLOWING
• GRADE1:- No typical cell-normal ( negative smear)
• GRADE2:- Atypical cells as occurs in infection and metaplasia…no
evidence of malignancy (atypical smear)
• Follow –up study suggested following treatment of infection
• GRADE3:-Atypic due to marked dysplasia ( suspicious smear)suggested
follow up smear. If positive further investigations by cervical biopsy and
curettage
• GRADE4:- Marked dysplasia with few suspicious malignant cells ( positive
smear),suggested cervical biopsy and curettage
• DRADE5:-Large number of malignant cells(positive smear)suggested
cervical biopsy and curettage

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Digital mammogram
• To find out the malignancy in mammary
glands
• To find out the extend of metastasis

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• Advanced technologies are the one which play
a vital part in the assessment, diagnosis and
treatment….which provides a high level of
well being and prevention of possible
complications in the life of obstetrical and
gynecological patients …….

SPECIAL DIAGNOSTIC TESTS IN MIDWIFERY

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