‘Abnormal’ Papanicolaou smears and colposcopy in pregnancy: ante- and post-partum findings

Abstract

Abnormal Papanicolaou smears and colposcopic findings suggesting human Papilloma virus (HPV) infection and cervical intraepithelial neoplasia (CIN) may occur during pregnancy. Condylomata acuminata often grow rapidly during pregnancy and may regress spontaneously following delivery. However, the post-partum outcome of the untreated ante-partum abnormal cytologic smear and colposcopy has not been defined clearly. Seventy-three pregnant patients were examined by colposcopy because of genital warts and/or abnormal Papanicolaou smears. Cytologic, colposcopic and histologic re-evaluation was conducted after delivery. Only one of the patients had a normal ante-partum colposcopic examination. This number increased to 15 after delivery. Forty-one patients had normal post-partum cytologic smears, but only 13 had normal histology. Abnormal post-partum cytology was highly predictive of abnormal colposcopy and histology. In contrast, normal post-partum cytology was not very accurate in predicting normal colposcopy and histology. It is concluded that a few pregnant patients may have partial regression of clinical HPV infection and abnormal cytology and colposcopy after delivery. However, the majority will continue to have abnormal findings 4 months following delivery in spite of normal post-partum cytology and even colposcopy.

Cervical intraepithelial neoplasia in pregnancy

“…In accordance with previously published but rather small series (5,8,9), we found a high persistence rate of CIN diagnosed during pregnancy. Thus 75% of the patients in our study had persistent or progressive disease at postpartum evaluation, while spontaneous regression of CIN occurred in only 25%.…”

Cervical intraepithelial neoplasia in pregnancy

“…In accordance with previously published but rather small series (5,8,9), we found a high persistence rate of CIN diagnosed during pregnancy. Thus 75% of the patients in our study had persistent or progressive disease at postpartum evaluation, while spontaneous regression of CIN occurred in only 25%.…”

Diagnostic et prise en charge des lésions précancéreuses du col utérin pendant la grossesse

“…Cependant, elle peut se compliquer d'hémorragie, d'autant plus fré-quente que la grossesse est avancée. De manière globale, le risque hémorragique d'une biopsie cervicale chez une femme enceinte est estimé entre 0 et 5 % [22,36,40,[44][45][46][47][48][49]. Le risque hémorragique peut être réduit par l'utilisation de pinces à biopsie de petite taille et parfaitement coupantes (NP4) [22,46].…”

“…Les risques obstétri-caux (contractions utérines, fausse couche, accouchement prématuré) des biopsies sont quasiment nuls (NP3). La corré-lation entre le diagnostic histologique de la biopsie en cours de grossesse et le diagnostic final est bonne, se situant entre 43 et 95 % [22,36,45,46,48].…”