OG19.3,OG35.{15-18,20},OG36.3 | Core Procedural Skills — Glossary

Blanching of dysplastic or metaplastic cervical epithelium after application of 3-5% acetic acid, due to protein coagulation; the visual target for directed biopsy during colposcopy.

Bethesda category indicating atypical glandular cells of endocervical or endometrial origin; high clinical significance requiring colposcopy and endocervical assessment.

Distortion of cervical cytology cells caused by exposure to air before fixation; causes nuclear swelling and chromatin smearing, leading to unsatisfactory or over-called smear results.

A long plastic instrument with a small notched tip used to rupture the fetal membranes under direct vaginal guidance during ARM.

A deliberate, iatrogenic rupture of the amniochorionic membrane using an amnihook or Kocher's forceps to augment or induce labour; requires the fetal head to be engaged to prevent cord prolapse.

Atypical Squamous Cells of Undetermined Significance — the most common abnormal Pap result; managed with HPV reflex testing or repeat cytology.

A strict infection-control procedure for catheterisation in which the catheter itself (the 'key part') must never be touched by anything non-sterile; maintains a sterile field throughout.

The standardised international classification for reporting cervical cytology results, including specimen adequacy assessment and categories from NILM to carcinoma.

A urinary tract infection developing in a patient with an indwelling catheter; the most common healthcare-associated infection; risk increases with each day of catheterisation.

A spectrum of dysplastic (pre-invasive) changes confined to the cervical epithelium, graded CIN 1 (lower third involvement) through CIN 3 (full-thickness involvement); detected by biopsy histology.

Infection of the amniotic membranes and fluid, typically ascending after membrane rupture; characterised by maternal fever, tachycardia, uterine tenderness, and offensive liquor; requires IV antibiotics and expedited delivery.

The physiological presence of columnar (endocervical) epithelium on the visible ectocervix; appears red and velvety; not a pre-malignant lesion.

Descent of the umbilical cord through the cervical os ahead of or alongside the presenting part after membrane rupture; a life-threatening obstetric emergency requiring immediate delivery.

US Collaborative Review of Sterilization — a long-term prospective study reporting 10-year cumulative failure rates for each tubal ligation technique; overall 10-year failure approximately 1.85%; source of evidence for sterilisation counselling.

The standard copper intrauterine device with 380 mm2 copper surface area; effective for up to 10 years; the primary IUCD used in India's national family planning programme under RMNCH+A.

Post-coital contraception used within 5 days of unprotected intercourse; copper IUCD (failure rate below 0.1%) is the most effective option, superior to ulipristal acetate and levonorgestrel EC pills.

Scraping of the endocervical canal with a small curette to collect cells/tissue for histology; indicated when the squamocolumnar junction is not fully visible or when glandular disease is suspected.

A deliberate surgical incision of the perineum made at the time of delivery to enlarge the vaginal opening; current evidence supports selective rather than routine use.

Descent of an IUCD from its fundal position into the lower uterine segment, cervical canal, or vagina; associated with loss of contraceptive protection; recognised on thread check or ultrasound.

Tubal ligation technique in which the fimbriated (distal) end of the tube is ligated and excised; the lowest reversal potential of all techniques; used when the isthmus is inaccessible.

An indwelling self-retaining urinary catheter with an inflatable balloon; used for continuous bladder drainage in obstetric patients requiring output monitoring or prolonged catheterisation.

A perineal tear involving both the external and internal anal sphincters and the rectal mucosa; requires repair in an operating theatre by a senior obstetrician or colorectal surgeon.

Correct positioning of an IUCD at the fundus (topmost point) of the uterine cavity; associated with lowest expulsion rate and highest contraceptive efficacy; confirmed by transvaginal ultrasound when in doubt.

High-Grade Squamous Intraepithelial Lesion — a Bethesda cytology category corresponding to CIN 2-3 histologically; mandates colposcopy and biopsy.

A T-shaped device placed within the uterine cavity to prevent pregnancy; copper IUCDs act by a spermicidal mechanism (copper ions impair sperm motility and fertilisation); levonorgestrel-releasing IUDs act by local endometrial and cervical effects.

A tubal ligation technique in which the divided proximal tubal end is buried in the myometrium and the distal end in the broad ligament; very low failure rate; requires greater surgical skill.

Tubal occlusion performed via laparoscope using a silicone ring (Falope ring), Filshie or Hulka clip, or bipolar diathermy; requires general anaesthesia and pneumoperitoneum; used for interval sterilisation in equipped centres.

A Pap smear technique in which the sampling device is rinsed into a liquid-fixative vial rather than smeared on a glass slide; produces a cleaner monolayer and reduces unsatisfactory rate.

A therapeutic excision procedure using a diathermy loop to remove the transformation zone en bloc; both diagnostic (provides a histological specimen) and therapeutic for CIN 2-3.

A T-shaped hormonal intrauterine system (Mirena 52 mg) releasing 20 mcg/day levonorgestrel locally; effective for 5 years; reduces menstrual flow; first-line option for heavy menstrual bleeding with concurrent contraception.

Amniotic fluid stained green-brown by fetal meconium passage, indicating fetal distress; requires continuous CTG monitoring and neonatal resuscitation team standby at delivery.

An episiotomy incision directed at 45-60° lateral to the midline, deliberately avoiding the external anal sphincter; the standard technique in India and the UK.

The peritoneal fold of the broad ligament running below the fallopian tube and containing its blood supply; inadvertent injury during tubal ligation causes the most common intraoperative complication — mesosalpinx bleeding.

A small surgical incision (2-3 cm) used for tubal ligation; subumbilical for postpartum (uterus enlarged to umbilicus); suprapubic for interval procedures; does not require laparoscopic equipment.

The most common tubal ligation technique in India: a loop of the isthmo-ampullary tube is ligated at its base with an absorbable suture and excised; the cut ends seal by fibrosis as the suture dissolves.

Ferric subsulfate paste applied to post-biopsy bleeding sites for haemostasis; leaves a brown-black stain on the cervix that must be documented to avoid colposcopic misinterpretation.

Negative for Intraepithelial Lesion or Malignancy — a Bethesda category indicating a normal Pap smear result; routine recall per screening schedule.

The central fibromuscular mass at the meeting point of multiple perineal muscles; its integrity is critical for pelvic floor support and continence; disruption during delivery must be identified and repaired.

An absorbable synthetic braided suture material used for episiotomy repair; associated with less pain and equivalent wound healing compared to catgut.

Distress or regret experienced after tubal ligation, most commonly in women who were sterilised at a young age, after a recent loss, or under coercion; the primary reason for requesting reversal or IVF.

Postpartum IUCD insertion — device placed within 48 hours of delivery (manually after placental delivery at vaginal birth, or through the uterotomy at caesarean section); a national priority LARC in India's RMNCH+A programme.

A fibromuscular cord running from the uterine cornua to the inguinal canal; anatomically adjacent to the fallopian tube and a common wrong-structure ligation; distinguished from the tube by its solid core and course (toward the inguinal region, not the ovary).

Application of Lugol's iodine to the cervix; glycogen-rich normal squamous epithelium stains mahogany-brown (iodine-positive), while dysplastic/metaplastic areas remain unstained (iodine-negative, Schiller-positive).

The boundary between the stratified squamous epithelium of the ectocervix and the columnar epithelium of the endocervix; its position varies with age and hormonal status.

A continuous suture placed just beneath the skin surface (in the dermis/subcutis) to close a wound without external visible stitches; preferred for perineal skin closure as it causes less postpartum pain than interrupted surface sutures.

A perineal tear extending to involve the external anal sphincter (EAS); classified as 3a (<50% EAS thickness), 3b (>50% EAS thickness), or 3c (EAS plus internal anal sphincter); requires specialist repair.

A small punch-biopsy instrument used to take 3-5 mm cervical tissue cores under direct colposcopic guidance; specimens must be immediately placed in 10% formalin for histological processing.

The area on the cervix between the original and current squamocolumnar junction, lined by metaplastic squamous epithelium; the site of origin of virtually all cervical intraepithelial neoplasia and cervical cancers.

Female surgical sterilisation by bilateral occlusion or removal of a segment of the fallopian tubes; the most commonly used contraceptive method in India; a permanent procedure.

A tubal ligation technique using submucosal saline injection to separate the tubal serosa from the muscularis; the muscularis is excised while the serosa is preserved; low failure rate with some reversal potential.

Rare complication of IUCD insertion in which the instrument penetrates the uterine wall; incidence approximately 1-2 per 1,000 insertions; requires laparoscopic or open surgical retrieval of the device.

Introduction of a calibrated metal sound through the cervical os to measure uterine cavity depth; essential safety step before IUCD insertion to confirm cavity dimensions (normal 6-8 cm) and detect perforation risk.

A low-cost, resource-appropriate cervical cancer screening method in which 5% acetic acid is applied and acetowhite lesions are visually identified; used in resource-limited settings per WHO guidelines.

A single-toothed forceps applied to the anterior lip of the cervix during IUCD insertion to provide counter-traction and straighten the uterocervical axis for safe sounding and device insertion.

An evidence-based classification system for contraceptive eligibility, from Category 1 (no restriction) to Category 4 (absolute contraindication); the standard framework for IUCD and contraceptive counselling globally.

The standard CuT 380A deployment method: the outer insertion tube is withdrawn while the central insertion rod is held stationary, releasing the arms at the fundus; advancing the rod (the error) moves the device downward.