Screening for cervical cancer during pregnancy

Abstract

INTRODUCTIONCervical cancer is one of the most common malignancy among females, worldwide.1 Every year, more than 493,000 individuals are diagnosed with and 274,000 die from cervical cancer. The majority of these cases (80%) are experienced in developing countries.2 PAP smear is the most sensitive and specific screening test for cervical cancer in reducing mortality and morbidity of women. However, high incidence and mortality rates continue in developing countries due to the lack of screening programmes. 4 In India it is an important public health problem for women leading to annual mortality of ABSTRACT Background: Carcinoma cervix is the second most common gynaecological cancer causing deaths among women. PAP smear being most sensitive and specific screening test reducing mortality and morbidity, can be used to identify early changes in cervix during pregnancy. The aim of the study was to offer cervical cancer screening for pregnant women and motivate them into the mainstream of screening subsequently and evaluate their acceptance. Also to identify reproductive tract infections, associated pregnancy changes and their effect on pregnancy outcome. This prospective study enrolled 200 normal pregnant patients admitted at Sri Rama Krishna Hospital from September 2012 to January 2014. Methods: All the patients selected for this study underwent history taking and examination .Pap smear was taken with patient in dorsal position. Among 200 cases, 196 (98%) were adequate smears and only 4 (2%) were inadequate. Adequate smears which were grouped as per Bethesda system, majority (97.5%) fell in Group I and were found to be normal or inflammatory smear, while only one showed ASCUS. Of the cases in Group I, 114 cases (57%) showed inflammation while 81 cases (40.5%) were normal. Statistical analysis used was SPSS 11.5. Results: Majority of the patients involved in study were in the age group of 20-35years with only 3.5% below 19yrs and 2% above 35years with mean age of 26.9years. Most of the patients were married at 20-30yrs of age while only 4.5% were married after 30 with mean age of marriage 23.4yrs. Importantly 15% had an early marriage between 15-19yrs. Most of patients who consented for study belonged to third trimester (91.5%) followed second trimester (17%) with average of 32.7wks. About 80% had knowledge regarding screening for cervical cancer. Statistical analysis used was SPSS 11.5. Conclusions: PAP smear being a cost effective, easy to perform test, can be carried out even in pregnant woman. It does not interfere with the natural course of pregnancy and hence safety is ensured. Pregnancy is a potential opportunity to counsel and educate them regarding the significance of screening.

Pap smear in antepartum women: an opportunity to screen and create awareness

“…This is in contrast to study results conducted at Coimbatore by Manikkam, where 80% of women and Turkish studies showed that 60.7% women were aware of Pap smear. 3,11 This difference may be due to difference in population characteristics under study.…”

“…2 This also provides an opportunity to educate and create awareness about cancer cervix and motivate them for future regular Pap smear screening for themselves and members of her community. 11 In addition, Pap smear also gives information about genital infections such as bacteria, fungus, virus etc. This provides an opportunity to detect asymptomatic genital infections and there by treat it, which otherwise could have an adverse effect on ongoing pregnancy outcomes.…”

“…This provides an opportunity to detect asymptomatic genital infections and there by treat it, which otherwise could have an adverse effect on ongoing pregnancy outcomes. 11,12 Cervical screening during pregnancy is a special circumstance where additional concern is about the wellbeing of the fetus. Pap smear during ante-natal period poses no risk to the fetus and is not associated with an increased rate of miscarriage or preterm labor.…”

Perceptions of Midwives on Pap Smear Tests during Pregnancy

“…Pregnancy is a potential opportunity to counsel and educate pregnant women regarding the significance of Pap smear (Manikkam, 2016). Studies have confirmed that Pap smear test is safely done during pregnancy irrespective of gestational age (Botha and Dreyer, 2017;Heena et al, 2019;Manikkam, 2016). Progressively, several studies have confirmed positive intraepithelial lesions detected during pregnancy (Ncube et al, 2019, Manikkam, 2016.…”

“…This is to avoid missed opportunities among pregnant women (DoH, 2017). Pregnancy is a potential opportunity to counsel and educate pregnant women regarding the significance of Pap smear (Manikkam, 2016). Studies have confirmed that Pap smear test is safely done during pregnancy irrespective of gestational age (Botha and Dreyer, 2017;Heena et al, 2019;Manikkam, 2016).…”