Effect of Cervical Wiping with Sterile Cotton on the Quality of Pap-smear.

Abstract

Abstract: Introduction: Cervical cancer as one of the most common cancers in women, can be detected with a Pap smear. Efforts to improve the quality of Pap smear is essential. There are conflicting reports about the effect of wiping cervix with cotton on Pap smear result. Therefore, we aimed to do a research about this subject. Methods: This study, was carried out attended at the Al –Zahra educational hospital, Rasht, 2011. 234 eligible women were enrolled in the study. Samples were allocated by block randomization into two groups. The block size were 4 and 6. To hide the allocation sequence we used the sealed opaque envelopes with consecutive numbers which prepared by researcher assistant. Data collection instrument had three parts (demographic characteristics, Vulvovaginal and Laboratory assay). The first part of the data collection form was completed by researcher. After placement of women in lytatumi position a speculum inserted and second part of the form completed. Then the participant's allocated group were determined by opening the envelopes after filling the second part of the form. In the intervention group, we cleaned cervix with a sterile cotton rotating 360 degrees and obtained samples using spatula for exocervix and cytobrush for endocervix. This method was performed without cleaning the cervix on the control group. The slides with coded questionnaires were sent to the hospital pathology lab. The smears were stained by Papanicolaou method. The pathologist who was blinded to the allocation interpreted the slides according to the 2001 Bethesda System. The data were analyzed using logistic regression in SPSS 13. Results: Rate of sufficient endocervical cell of the slides in the intervention group was significantly higher than in the control group (70.3% vs 57.8%, p=0.03). 42.4of the slides in the intervention group were satisfactory and ۵۷.۶% had limited quality for interpretation. These figures in the control group were 37.1% and 62.9%, respectively. This difference was not statistically significant. Also, there was no significant difference between the groups on rate of slides with inadequacy of squamous cells and obscuring 75% or more of the slides with inflammatory exudate or blood (p> 0.05). Conclusion: There were no significant differences between the groups on some quality indicators of the smears. However, frequency of smears with sufficient endocervical cells was higher in the group with cervical wiping. Therefore, it is recommended to clean cervix before obtaining the smears.