स्त्री एवं बाल रोग का विभाग
एस.ओ.पी.
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 17th,19th,21st
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
SOPs of Lab Procedures
Standard Operating Procedure
Of
CBC Analyzer Step wise
Switch on the power supply of the Analyzer
Enter the code of Machine
Wait for machine running procedure
Before this put the blood samples (EDTA) on blood rotator to mix the sample well
Now machine is ready to work
Enter the patients information like Name, Age, Sex etc
Suck the blood sample via sample probe
Wait for reading
Printout the reading by giving Command to print
Write down the reading in lab record register
For multiple samples repeat the procedure
After completing the work shutdown the analyzer after cleaning procedure
By sucking probe cleanser via sample probe
And at the end switch off the power supply to the machine
Standard Operating Procedure
of
Weighing Balance- Step Wise
The weighing equipment must be placed on a firm bench, away from vibration
It should be kept perfectly horizontal by altering the screws on which the equipment stand
Switch on the power supply to the weighing balance
Place a piece of Aluminum foil or sterile paper in the weighing balance
Adjust the reading at 0
Put the salt or weighing object on the foil
Before taking the reading the window of the instrument should be closed
Note the reading
Repeat the procedure for another reading
Standard Operating Procedure
of
Microscopy- Step Wise
Switch on the power supply to the Microscope
Place the slide on the Mechanical Stage
Hold the slide with spring clips
Centering the condenser to bring light beam accurately
Adjust the light source to the desired level by moving the wheel
Adjust the eye piece lens
Adjust the Objective Lens on the slide
Focus at low magnification (10X) by controlling the knobs of Coarse and Fine adjustment
Later on focus on high magnification (40 X or 100 X ) according to need
Then reporting is done
Standard Operating Procedure
of
Centrifuge –Step wise
Switch on the power supply to the centrifuge
Open the lid of the centrifuge
Put the sample test tube into the centrifuge
Test tube should be in balanced position
Set the time for centrifugation
Set the RPM(Rotation per Minute) for centrifugation
By pushing the start button start the centrifugation
After completion of holding time centrifuge automatically stops
Take out sample and it is ready to use
Standard Operating Procedure
of
Calorimeter-
Step Wise
Switch on the power supply to instrument
Select the wave length of the filter from 420nm to 720nm as required by sample
Adjust the filter by filter selector
Fill the Cuvette with distilled water
Put it into the cuvette holder with the mark along with the cuvette alignment
Allow the Depressor for light transmission from the cuvette
Set the calorimeter reading at zero by adjusting the coarse and fine adjustment wheels
Take out the cuvette and fill with sample
Then take the reading at the meter
Repeat the method for another reading
Standard Operating Procedure
of
Incubator
Switch on the power supply to the Incubator
Open the lid of the incubator
Place the articles like test tube, beakers etc into the incubator
Set the temperature by regulating unit for a desirable temperature like 37°C
It is thermostatically controlled unit
Hold the articles for a required incubation time
After incubation time take out the articles
And use them
Standard Operating Procedure
of
Autoclave
A type of moist heat sterilization
Is made of strong metal jacket
Strong enough to withstand on high pressure
Fill the boiler with water at point just below the basket bottom
Place articles within the basket
Close the lid and tighten the screw
Switch on the power supply to the IncubatorOpen outlet valve and adjust safety valve to the pressure required
Turn all the heat source where steam flows smoothly
Let pressure raised and maintained at required level i.e.
Switch off the heat source and let the pressure meter zero
Standard Operating Procedure
of
Pap Smear Cytology:- Step wise
After passing urine, ask the patient to lie down in Lithotomy position
Expose the vulva and clean it with the cotton swab dipped in normal warm Saline
Insert the Cusco’s speculum and fix it to visualize the cervix and squamo-columnar junction
Take out the sterilized Ayer’s spatula
Put it on the ectocervix and scrap it in clockwise direction gently once
Spread the mucous collected smoothly on the slides
Then insert the cytobrush into the endocervical canal
Rotate it gently ¼ or1/2 turn in one direction. Don’t over rotate
Spread the contents of Cytobrush on the glass slides, to make a thin smear slide
Fix the slides with Alcohol.
Label the sample and send it to cytopathology laboratory
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.
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