Maturation index in mid-secretory phase of menstrual cycle is
Basics: Estrogen Promotes, Progesterone inhibits Squamous cell maturation The lateral vaginal wall cells can be sampled by scraping them with a spatula and then plating them on a slide. Sample often obtained simultaneous with Pap smear. (Students should not confuse that squamous cells sampled from the lateral vaginal wall is same as taking a paps smear from the cervix) The vagina is sampled at middle third of lateral vaginal wall. This is used for detecting hormonal effects in menopausal and postmenopausal women, though this will have a paicular value in all stages of a woman's life This is Indicated for : Assessment of ovarian function. -During pubey & reproductive, menopausal & post menopausal years -Assessment of ovarian function in menstrual disorders -Can also be used for diagnosing ovulation. Maturation Index (MI)The vaginal epithelium has Basal, Parabasal, Intermediate and Superficial cells. 100 exfoliated cells are counted and the MI is defined as ratio of parabasal to intermediate to superficial cells of vaginal epithelium. These cells are as presented as a 3 pa ratio with the Para basal cells staed 1st , intermediate cells 2nd & superficial cells 3rd. For eg: MI = 80 /20 / 0 Indicates :80 % - Parabasal cells 20 % - Intermediate cells 0 % - Superficial cells Increase in estrogen levelenlarges the parabasal cells to become intermediate cells and then this will continue to enlarge & mature into keratinized superficial cells. The superficial cells are most abundant during proliferating phase. These cells are polygonal with abundant eosinophilic cytoplasm. There will be more deposition of glycogen in the vaginal epithelium. High estrogenic effect in a vaginal smear is recognized by a clean background & increased eosinophilic & karyopyknotic indices(Given below). High progesterone levels promotes proliferation of intermediate squamous epithelium. These cells are polygonal in shape -with abundant bluish cytoplasm & seen during secretory phase. Parabasal cells are Immature squamous cell which are round to oval. Nucleus is relatively large. Hence, in a lateral vaginal wall smear, if the cells show... Shift to left - atrophic effect. Shift to right - Increased estrogen effect. More mid-zone cells - Progesterone effect With increasing estrogen, the MI is 0/10/90 With increasing Progesterone the ratio is 0/90/10 With increasing Androgen it is 20/80/0 With Pre Ovulatory phase it is 0/40/60 With Post ovulatory phase it is 0/70/30 During menopause it is 0/80/20 Late menopause 100/0/0 EOSINOPHILIC INDEX (EI)Ratio of eosinophillic cells to basophillic cells. This is given in a ratio. Parabasal cells not counted. Karyopyknotic Index (KI)Ratio of Superficial cells to Intermediate cells
0/95/5
80/20/0
0/70/30
0/40/60
Normal Menstruation, Abnormal Menstruation, Menopausal Physiology and forsight of conception