Department of Amraz-e-Niswan-Wa-Atfal

SOPs

Dept. data last updated on :18/04/2024

SOP of PAP Smear

PAP’S SMEAR CYTOLOGY

INDICATIONS:

3 years of marriage or 21 year of age whichever is earlier.
Repeat annually
After age 30 years with 3 consecutive normal pap smear, repeat at every 3 year.
In HIV positive patient, repeat annually.
In HPV positive patient, repeat indefinitely.
Age 70, low risk, 3 consecutive normal pap smear, stop screening.
In poor countries, WHO recommended 5 years 5 test between the age of 35 to 55 years.

TEST REQUISITION:

Minimal clinical data like: Name, Age, LMP, Onset of menopause, Menstrual abnormality, Pregnancy status.

PATIENT PREPERATION:

Pt should be tested 2 weeks after the first day of LMP.(Day 14 of the cycle is optimal)
No use of vaginal medication, contraceptives, during 48 hrs prior to sample collection.
Abstinence for 24 hours prior to test.
Ask pt. to empty her bladder & lie in lithotomy position.

PROCEDURE:

Sterile non-lubricated speculum inserted and fix it to visualize the cervix and squamo-columnar junction
Excess mucus & other discharge removed gently with ring forcep or folded gauze pad.
Take sample from endocervix with cytobrush. Insert 2cm and rotate 180^◦.
Take sample from ectocervix with wooden Ayre spatula by inserting and rotating it 360^◦.
Make smear as thin as possible & label it properly.
Remove speculum
Fix the slide immediately with alcohol solution to avoid air-drying artifacts.

Optimal sample should have cells from ectocervix & endocervix.
Send sample for cytology.

SOP of Office

SOPs for the Office:

Official Working Hours 8:00 AM – 4:00 PM
The concerned person will collect the keys from Chairperson and open the Department at 7:45 AM, followed by the office, laboratories, chambers of the staff, etc.
Before closing the Department, all the electrical switches and water taps will be checked by the person designated by the chairperson of the Department.
Cleaning and dusting of the department will be done on a daily basis by the unskilled staff.
All the staff should update the notice board regularly.
Concerned staff must update the departmental web page regularly.

Receive and Dispatch:

All the papers received in the office of the department, the details of the paper will be entered in the receipt register.
The office clerk will put the papers before the chairperson for necessary comments, and the papers will be returned to the office for the record or necessary action as marked by the chairperson.
The papers will be placed in the respective file folder.
The details of all the papers which are to be dispatched from the office will be entered in the dispatch register.
Dispatched letters will be sent to the respective officers on the same day.

SOP of Seminar Library

Policy and procedures for Seminar Library:

The seminar shall remain open on all working days.
The seminar library books are kept in glass almirah with accession numbers provided by Maulana Azad Library.
The services of the Departmental Seminar will be provided to the Teaching Staff, Post Graduate Students, and Interns of the Departments.
In special circumstances, the services of the seminar library may be extended to the other students of the AMU with the permission of the Chairperson.
The department will maintain an Accession Register and a Record of issuing the books as per norms/ rules of the seminar library.
Seminar in charge will also maintain the separate register for Departmental Seminar and Journal Club.

Return Policy of Library books:

Academic Staff: 4 books will be issued for two weeks.
Non-Academic Staff: 2 books will be issued for five days.
Research Scholars: 2 books will be issued for one week.

SOP of CTG

CARTIOTOCOGRAPHY (CTG)

It is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother’s abdomen.

AIM:

To reduce the incidence of fetal/ neonatal morbidity and mortality when monitoring fetal well-being during the antennal period.

INDICATIONS:

Maternal medical illness: Gestational diabetes, hypertension, asthma, etc.

Obstetrical complications: Multiple gestation, postdate gestation, previous caesarian section, IUGR, premature rupture of membrane, congenital malformation, oxytocin induction/ augmentation of labour.

SOPS of Cardiotocography (CTG):

Pre-requisites:

· CTG machine

· Trained Staff

· Informed consent

Procedures:

Ask the patient to empty her bladder

Lie in supine position. In some cases in left lateral position

Auscultate the FHR prior to CTG.

External (non-invasive) method:

Done by USG Doppler effects, from maternal abdominal wall.

Two transducers, the tocodynamometer (toco) and the ultrasound device are placed at the patient’s abdomen

FHR displayed in the special monitor paper and is audible also.

The uterine contractions are displayed on the special monitor paper as well.

Interpretations:

· Machine can meet criteria as quickly as 10 minutes and as long as 60 minutes.

· CTG must be interpreted on an individual basis, the whole clinical picture must be considered, must be interpreted.

· CTG should be classified as either Normal or abnormal.

Limitations:

· Cannot be used as predictive or screening test.

· Only indicates current fetal state.

· Cannot predict catastrophes. Like, sudden abruption.

SOP of Dry Cupping

SOPs FOR DRY CUPPING THERAPY (For Dysmenorrhea & Low Backache for patients of Chronic Cervicitis)

MATERIAL REQUIRED:

· Disposable Gloves

· Sterile Cotton

· Anti-inflammatory analgesic oil/bland oil(As per requirement)

· Cups

INSTRUCTIONS:

· It can be done on any day as per requirement but it is better to do it on 17^th,19^th,21^st day of lunar month in the morning.

· Brief history of the patient should be taken.

· Inform patient about the therapy.

· Ask patient to empty her bladder.

Procedure:

· Put on gloves in clean hands.

· Ask patient to lie down in supine position.

· Palpate area where the cups are to be applied to rule out any local lesion, tenderness etc.

· Apply small amount of oil/ointment at that area.

· Put on cup over it, create slight vaccum and gently massage in to and fro circular motion at lower abdomen, on peri umblical region for about 2 minutes to increase blood flow of that area.

· Now apply 1 cup each side on lower abdomen at suprapubic region with appropriate vaccum for 10 mins.

· After 10 minutes, release negative pressure and remove cups.

· Clean that area with cotton.

· Dispose off cotton and gloves.

· Wash clean and dry cup to use in next patient.

SOP Colposcopy

COLPOSCOPY

Standard Operative Procedures

Aware pt. about the procedure

↓

Take written informed consent

↓

Pre-reqeuisities of procedure

(eg;aseptic measures, bladder emptying etc)

↓

Pt placed in lithotomy position

↓

Local examination of external genitalia done

↓

Visualise cervix using cusco’s speculum

↓

Colposcopic examination of cervix and vagina by low power magnification(6 -16 folds)

↓

Examine inflammation/outgrowth/ulcers/bleeding.

↓

Locate ext. os and SCJ

↓

Abnormal cytology is checked (if any) culture or pap smear is obtained(if necessary for conforming diagnosis).

↓

Clean cx. with NS

↓

Green & high magnification can be used

↓

Cx. wiped gently with 3-5% acetic acid

↓

Examination repeated for any aceto-white area & TZ zone

↓

Clear excess acetic acid from cx.

↓

Apply lugol’s iodine & inspect for its uptake

↓

Remove cusco’s speculum

↓

Interpret the findings by Reid’s/Swede score

↓

Documentation of findings

↓

Reassure/ Counsel/ Treat pt accordingly

Cu-T INSERTION

SOPs of Cu-T INSERTION

PRELIMINARIES:

History and examination of (general and pelvic) to exclude any contraindication of insertion.
Patient should be informed about various problems related to it
Device should be shown to patient.
Consent should be obtained.
Insertion should be done in OPD under aseptic precautions.
NSAIDs may be given to reduce cramping pain.
Device is taken out from sealed packet. Thread, vertical stem, then horizontal stem, folded to vertical stem are introduced through the distal end of the inserter.

STEPS:

Ask patient to empty her bladder, Lie in lithotomy position and assess her by pelvic examination.
Posterior vaginal speculum is introduced
Vagina and cervix are cleaned by antiseptic solution.
Ant lip of cervix is grasped by alli’s forcep.
Uterine sound is passed through the cervical canal to note the position and length of the uterus.
Appropriate length of the inserter should be adjusted depending on the length of the uterine cavity.
Then inserter with the device is inserted in the cervical canal right upto the fundus and after positioning it by the guard,inserter is withdrawn keeping the plunger in position.
Excess of the nylon thread beyond 2-3 cm from the external os is cut.
Alli’s forcep and posterior vaginal wall speculum are taken off.

ADVICE TO PATIENT:

Pain and slight bleeding may occur
Ask her to feel thread periodically by fingers
Ask her to consult gynaecologist if symptoms like pain, abnormal bleeding, foul smelling P/V discharge, etc present.
Patient should be checked after 1 month and then annually.