CERVICAL NEOPLASIA IN PREGNANCY
A 25-year-old woman with intrauterine pregnancy at 14 weeks by dates is
referred because of a Pap smear showing as HSIL (high-grade squamous
intraepithelial lesion). On pelvic examination there is a gravid uterus
consistent with 14 weeks size, and the cervix is grossly normal to visual
inspection.Diagnostic Tests/Findings
Management.
Effect of pregnancy. Pregnancy per se does not predispose to abnormal
cytology and does not accelerate precancerous lesion progression into
invasive carcinoma.
Colposcopy and biopsy. A patient who is pregnant with an abnormal Pap
smear should be evaluated in the same fashion as when in a nonpregnant state.
An abnormal Pap smear is followed with colposcopy with the aid of acetic
acid for better visualization of the cervix. Any abnormal lesions of the
ectocervix are biopsied.
Perform an ECC? Owing to increased cervical vascularity, ECC is not
performed during pregnancy.CIN. Patients with intraepithelial neoplasia or dysplasia should be followed
with Pap smear and colposcopy every three months during the pregnancy. At
6–8 weeks postpartum the patient should be reevaluated with repeat
colposcopy and Pap smear. Any persistent lesions can be definitively treated