**Question:** Procedure of choice in a woman with 12 weeks pregnancy and atypical pap smear is:

A. Transvaginal ultrasound
B. Colposcopy
C. Hysteroscopy
D. Hysterosalpingography

**Correct Answer:** **B. Colposcopy**

**Core Concept:** In a woman with a pregnancy of 12 weeks and an atypical pap smear, the most appropriate procedure to evaluate the cervix and potentially identify a cervical abnormality is **colposcopy**. Colposcopy is a procedure that allows direct visualisation and examination of the cervix under high-powered magnification using a colposcope. It can detect and evaluate abnormal cervical cells, tissue, or lesions, and guide the sampling of abnormal areas for further diagnostic tests, such as biopsies.

**Why the Correct Answer is Right:**

1. Colposcopy is a non-invasive procedure that can detect and evaluate cervical lesions, allowing for targeted sampling of abnormal areas for further diagnosis and treatment planning.
2. Atypical pap smear indicates an abnormal cervical cell sample, which may be due to various cervical abnormalities, including cervical intraepithelial neoplasia (CIN), which can progress to invasive cervical cancer if left untreated.
3. In a 12-week pregnancy, the procedure is deemed safe, as the risk of spontaneous abortion is relatively low at this gestational age.

**Why Each Wrong Option is Incorrect:**

1. A **transvaginal ultrasound** is an imaging procedure that assesses the uterine and fetal anatomy, not specifically evaluating cervical lesions.
2. **Hysteroscopy** is an invasive procedure that examines the uterine cavity, not the cervix.
3. **Hysterosalpingography** is an imaging procedure that assesses the uterus and fallopian tubes, not specifically evaluating cervical lesions.

**Clinical Pearl:**

Colposcopy is an essential tool for evaluating cervical lesions in pregnant women presenting with atypical pap smear results, as it allows for targeted sampling and appropriate management decisions to prevent cervical cancer progression. In a 12-week gestation, the procedure is generally safe, reducing the risk of abortion. Always consider the clinical context and patient history when selecting the most appropriate diagnostic procedure.