Colposcopically directed cervical biopsy during pregnancy; minor surgical and obstetrical complications and high rates of persistence and regression

Abstract

Investigation of atypical cytology during pregnancy with biopsy including large loop excisions is a safe procedure with regard to surgical complications and obstetrical outcome. There is a high rate of persistence and regression of dysplasia during pregnancy.

Natural history of cervical intraepithelial neoplasia in pregnancy: postpartum histo-pathologic outcome and review of the literature

“…Only data from studies where histological baseline and outcome information was available were summarized together with the presents study within the pooled analysis ( n = 8). Pooled analysis revealed overall regression, persistence, and progression rates of 46.8, 43.6, and 9.6 % for pregnant women with CIN, respectively [ 7 – 9 , 11 , 15 – 17 , 19 ].…”

“…Several studies reported that cone biopsy in pregnancy is associated with an impaired pregnancy outcome [ 25 , 26 ]. Other reports showed that loop electrosurgical excision procedures are safe during pregnancy with a miscarriage rate <1 % [ 17 ]. Due to the low rates of progression during pregnancy it is nowadays accepted that most patients may safely undergo expectant management if invasive disease has been ruled out [ 13 , 27 ].…”

“…In pregnant women with a diagnosis of CIN II–III the progression rate to invasive carcinoma ranges from 2 to 28 %, according to different reports. Ackermann et al and Everson et al have reported progression rates of 2.4 % [ 31 ] and 3 % [ 32 ], whereas Coppola et al [ 30 ], Kaplan et al [ 33 ], Kaerrberg et al [ 17 ] and Coppolillo et al [ 11 ] reported higher rates of 8, 11, 12 and 13 % respectively. Palle et al reported the highest rate of progression to invasive carcinoma during the postpartum period with an incidence of 28 % [ 16 ].…”

“…However the published literature reveals heterogeneous data about regression rates in pregnant women with CIN I between 32 and 69 % and CIN II-III between 16.7 to almost 70 %, respectively [ 7 , 9 , 11 – 14 ]. Additionally persistence rates, ranging from 38.4 up to 70 % [ 8 , 16 , 17 ] have been reported, thus leading to the recommendation of a close postpartum follow-up [ 8 , 11 , 16 , 18 ].…”

Non-invasive cervical cancer during pregnancy. Prognosis for mothers and children

“…По рекомендациям большинства зарубежных и отечественных экспертов тактика ведения беременных с CIN выжидательная, поскольку частота прогрессирования CIN2-3 (или плоскоклеточное эпителиальное поражение высокой степени -high grade squamous intraepithelial lesion, HSIL) в инвазивный рак после родов варьирует в диапазоне от 1,1 до 3,6 % случаев [5][6][7], однако ряд авторов регистрируют более высокие показатели -от 5,4 до 13,6 % [3,8]. По результатам нашего исследования прогрессирование CIN в инвазивный РШМ было выявлено после влагалищных родов лишь у 1 (0,9 %) из 110 женщин с первичным диагнозом CIN3 в сочетании с беременностью.…”