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  • Joyce C. Foster CNM, PhD, NAP, FAAN, FACNM,

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    • Joyce Cameron Foster is Professor of Nursing, Graduate Nurse-Midwifery Program, University of Utah and is in active practice at BirthCare-HealthCare, a faculty practice, community-based, primary health care, nurse-managed center and freestanding birth center. She received her BSN degree from UCLA in 1958, her MSN in maternal newborn nursing and certificate in nurse-midwifery from Yale in 1961, and her PhD in Health Science from the University of Utah in 1981.

  • Helen L. Smith CNM, MS

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    • Helen Louise Smith is currently a Commander in the U.S. Navy, where she is in active practice as a CNM. She received her BSN degree from Cornell University in 1974. She is a graduate of the University of Utah Nurse-Midwifery Program, where she received her MS degree in 1983. She is a former faculty member of the University of Utah Nurse-Midwifery Program.

Joyce C. Foster, Professor of Nursing, College of Nursing, Room 522, University of Utah, 25 South Medical Drive, Salt Lake City UT 84112.


A prospective, randomized clinical trial was conducted to study the safety and efficacy of the Cytobrush for Papanicolaou smear screens in 252 pregnant women. Two groups—Ayre spatula plus Cytobrush and Ayre spatula plus cotton swab—were compared. There was a higher incidence of spotting with each of the three devices as compared with studies of nonpregnant women. The highest incidence of spotting at time of exam occurred with the Cytobrush; however, this spotting was not clinically significant. Eleven first-trimester women experienced a pregnancy loss; five of these losses were due to a hydatidiform mole or missed abortion that occurred before the exam. Six women (2%) aborted spontaneously compared with a 10% incidence reported in the literature. It was concluded that all three devices are safe for use in pregnancy. In addition, the most adequate screen for retrieval of squamous epithelial cells was found to be the Ayre spatula, while the Cytobrush proved most effective for retrieval of endocervical epithelial cells.