الفهرس 
Histological changesin the cervix during pregnancyOnly 14 pages are availabe for public view
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Abstract
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sunnAny
This work was done to study firstly , the physiological changes that occur in transformation zone during pregnancy and puerperium . Secondly to study colposcopically the traumatic lesions of cervical epithelium after delivery and its healing process .
The subjects of this study consisted of two groups of women .
The first group consisted of 60 gravid females(30 primigravidae and 30 multigravidae) . Every woman was investigated clinically and colposcopically during each trimester of pregnancy and 6 to 8 weeks postpartum . For every woman age and gravidity were recorded . Clinical examination was done to check for gestational age and to estimate the degree of gaping of external cervical as during third trimester of pregnancy. Vaginal pH of gravidae at third trimester of pregnancy was compared to that in non pregnant stamen (60 cases) during secretory phase of menstrual cycle. After that every patient was examined colposcopically to observe the change that occurs in T. Z .
The second group consisted of 189 successive parturientsin whom colposcopic examination was done immediately after delivery and 6 to
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8 weeks postpartum to record cervical injuries and their healing process. For every patient full obstetric history was taken .
Analysis of the clinical and colposcopic finding enabled us to c.larify the results.
First group of women :
Gaping of the cervix
Gaping of the cervix occurred more commonkfia multiparae group (67%) than primiparae group (23%).
Vaginal pll
Vaginal pH was more acidic in pregnant women (4.6) than non pregnant women (5.8) . Lower vaginal pH in vaginal secretion may be the trigger for metaplastic process .
Colposcopic firidings
There was congestion and oedema of the cervix that increased as term approaches . Columnar papillae considerably increased in size . Eversion
In primiparae group the incidence of eversion increased as pregnancy
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progressed being 73% in first trimester , 90% in second trimester and 93% in third trimester. Absence of eversion occurred in 27% of primiparae group . Delivery was by CS. in 25% of cases with absent or minimal eversion during pregnancy due to cervical dystocia Absence of eversion in primigravidae during pregnancy may indicate the possibility of delivery by CS. due to cervical dystocia.
In multiparae group there was no significant increase in the incidence of eversion as pregnancy progressed being 40% in first and second trimester and 47% in third trimester. At 6 to 8 weeks postpartum, retraction of antepartum cervical eversion occurred in 38% of cases while postpartum eversion of endocervical mucosa occurred in 22% of cases Pregnancy forces the squamocolumnar junction into endocervical location . Transformation zone
During first trimester of pregnancy 10% of primigravidae showed evidence of early squamous metaplesia compared to 66% during the second trimester of pregnancy. Mature T. Z. occurred in 23% during postpartum period compared to 17% during third trimester of pregnancy and 7% during the first and second trimester
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primiparae group squamous metaplesia and maturation of T2. occurred with progression of pregnancy and during puerperium .
In multiparae group mature T. Z. occurred in 30% of cases during first and second trimester of pregnancy compared to 33% of ages dui* third trimester and 37% during postpartum period Multiparae women started pregnancy with mature T2.. There was no significant further squamous metaplesia in multiparae group as pregnancy progressed
The first pregnancy is usually the period of changes in epithelial components of the cervix .
Deciduosis
This condition was diagnosed in 6.6% of our cases .
Acanthosis
This condition was diagnosed colposcopically in one case .
In the second group of women
Colposcopic examination at immediate postpartum period Incidence of cervical injury
The incidence of cervical injury at immediate postpartum period was 66% Cervical erosion was found in 79% of cases with cervical injury
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compared to 53% for lacerations , 34% for bruising , 17% for yellow area. Degree of ceruical damage
The diameter of cervical erosion was less than 5 mm. in majority of cases (67%) . The diameter of cervical erosion increased in cases with P. R. M. Also the length of cervical laceration was less than 5 mm. in 63% of cases . Cervical laceration of first degree was found in 81% of cases .
Cervical injury at immediate postpartum period is usually small and has no clinical significance .
Site of cervical injury
The anterior cervical lip was injuried more frequently (57 %) titan the posterior lip (29%) .
factors inuolued in the production of cervical injury
In our study incidence of cervical injury in primiparae (77%) was statistically higher titan multiparae (59%) .
Cervical trauma occurred less frequencin occipito-anterior position (59%) titan occipito-posterior position (85%) .
Cervical trauma was more frequencin cases with premature rupture of membranes(83%) than in cases without P. R. M. (36%) .
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In our study the incidence of cervical trauma was not affected by age of parturient , duration of gestation , duraticm of labour , mode of delivery , fetal birth ’weight and number of birthsexcept the first .
Colposcopic examination 6 to 8 weeks postpartum
Residual ceruical injury
from 125 parturients with cervical injury at immediate postpartum period , 117 women was examined 6 to 8 weeks postpartum since 8 women refuced to be re-examined at that time . The incidence of residual cervic.al damage was 8% .
Location of squamocolumnar junction
Squamocolumnar junction was found to be endocervical in 51 % of 177 women examined 6 to 8 weeks postpartum . In 69% of cases beyond the age 25 years , the junction was endocervical , and 66 % of cases showed an endocervical junction at parity 2 or greater .