Journal of Postgraduate Medicine
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Year : 1986  |  Volume : 32  |  Issue : 4  |  Page : 210-3  

The value of vaginal cytology in prediction of labour with special reference to eosinophilic and karyopyknotic indices.

AA Pandit, AK Kalgutkar 
 

Correspondence Address:
A A Pandit





How to cite this article:
Pandit A A, Kalgutkar A K. The value of vaginal cytology in prediction of labour with special reference to eosinophilic and karyopyknotic indices. J Postgrad Med 1986;32:210-3


How to cite this URL:
Pandit A A, Kalgutkar A K. The value of vaginal cytology in prediction of labour with special reference to eosinophilic and karyopyknotic indices. J Postgrad Med [serial online] 1986 [cited 2019 Dec 8 ];32:210-3
Available from: http://www.jpgmonline.com/text.asp?1986/32/4/210/5321


Full Text



 INTRODUCTION



The increasing levels of the hormones after conception bring about changes in the vaginal epithelium. They can be detected by examination of the vaginal smear which reveals intermediate cell-clusters and navicular cells. This cytological pattern changes suddenly at the end of pregnancy due to drop in the. hormonal levels. The latter also brings about spontaneous labour within 5 days.[9], [13], [14] However, there is no unanimity about the relationship between the changed smear pattern and the onset of labour. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16]

In India, determination of biological pregnancy terns is of considerable practical importance, as many of the pregnant women attending general hospitals do not know the date of their last menstrual period. Also, in patients with irregular menses, the date of the last menstrual period cannot be relied upon to determine the expected date of delivery. In such case,. to predict the. date of labour, vaginal cytology is a simple and inexpensive parameter as compared to estimation of urinary total oestrogen, ultrasound studies and amniotic fluid analysis. In order to increase the predictability of vaginal cytology, in addition to subjective, classification of the smears into 'pre-term' and 'at-term' patterns, eosinophilic and karyopyknotic indices can be calculated.

 MATERIAL AND METHODS



Single smears were collected from 75 pregnant women in the age group of 18 to 40 years, attending antenatal clinic of J. J. Group of Hospitals, Bombay. The smears were obtained one week before the due date of delivery. They were collected from the upper one third of the lateral vaginal wall and were immediately fixed in ether-alcohol. The smears were stained with Papanicolau method and were categorized into three patterns: 1.'Pre-term' type, when the smear showed large clumps of cyanophilic intermediate cells and navicular cells uniformly distributed on the slide; 2. 'At-term' pattern which revealed single intermediate cells or occasional small clumps of intermediate cells and a very few navicular cells; 3. 'Post-term' or 'regressive' pattern, in which the cellular characteristics were similar to those noted in the 'at term' category, but they were more clear and distinctive. Parabasal cells were also seen in these smears.

In addition to this categorization of the smears, eosinophilic and karyophyknotic indices were calculated.[10] For this investigation, a total of one hundred cells were counted in four different microscopic fields under high power lens (magnification 40 x 10).

The time interval between the day of obtaining the smear and the date of delivery was noted, and its relationship with the smear pattern was recorded. The data was analysed by discriminant analysis.

 RESULTS



Out of 75 smears examined, 37 were of 'pre-term' type, 34 showed 'at-term' pattern, and 4 smears were of 'post-term' type.

The time interval between the date of obtaining the smear and the actual date of delivery is shown in [Table 1].

For the statistical analysis, eosinophilic and karyopyknotic indices were calculated in each case. Discriminant analysis was carried out with this two indices [Figure 1]. The separation function, T was obtained as:

T = X + 0.8763Y, where



X = v Eosinophilic index

and



Y = vKaryopyknotic index

This produced a highly effective separation of 'pre-term' and 'at-term' smears. The discriminant function for 'pre-term' type: was 4.58 (Tp) and for 'at-term' pattern was 5.24 (Ta). The mean of the two discriminants was 4.91, which was the cut off value for 'pre-term and 'at-term' patterns. In our data, none of the 'at-term' patterns had discriminant: less than 4.91, whereas only one 'pre-term' pattern showed a value greater than 4.91 (i.e. 4.92).

 DISCUSSION



The usefulness of vaginal cytology at the end of pregnancy for the prediction of labour has been studied by many workers. [1],[2],[3],[4],[5],[6], [8],[9],[10],[11],[12],[13],[14] Some found it to be useful[1],[2], [4],[5],[6] for the prediction of onset of labour whereas many others[1],[2], [4],[5],[6] came to the conclusion that there was no relationship between the smear pattern and the onset of labour. Therefore, Ortner[10] carried out discriminant analysis of eosinophilic and karyopyknotic indices and thus supplemented subjective criteria of cytological pattern determination with the objective criteria. The same method was followed by us. Our values of eosinophilic and karyopyknotic indices were lower than those obtained by Ortner[10] and T value was also low. We could separate 'pre-term' and 'at-term' patterns quite well without any overlapping. Our prediction of onset of labour from the smear pattern was correct in 73% of the patients. Thus, we find that vaginal cytology at the end of pregnancy is a useful parameter to predict the onset of labour in most cases

References

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