Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy

Gomez, Yvan; Balaya, Vincent; Lepigeon, Karine; Mathevet, Patrice; Jacot-Guillarmod, Martine

doi:10.3390/jcm10225319

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…However, only 10.2% of the variance could be explained by this model. In contrast, Gomez et al report a significant effect of parity on the likelihood of remission, whereas they were unable to determine an effect for delivery mode [41]. In our study, the determined influence on the course of dysplasia is small, there seem to be further influencing factors, which could not be investigated and evaluated in this work.…”

Section: Discussioncontrasting

confidence: 92%

“…The influence of the mode of delivery on the likelihood of postpartum remission is controversial. Some authors report increased rates of regression of CIN in women after vaginal delivery [27,39], whereas other studies demonstrate no influence [30,31,40,41]. The influence of the mode of delivery on postpartum outcome was assessed using ordinal logistic regression.…”

Section: Discussionmentioning

confidence: 99%

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Characterization and clinical management of abnormal cytology findings in pregnant women: a retrospective analysis

Freudenreich

Weiß

Engler

et al. 2022

Arch Gynecol Obstet

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Purpose The diagnosis of cervical intraepithelial neoplasia during pregnancy poses a great challenge to the treating clinician and the patient. According to the current guidelines, watchful waiting during pregnancy can be justified. Only in cases of invasion, immediate treatment may be indicated. However, few data are available on the management of cervical dysplasia during pregnancy. Further research is important for counselling affected women. Methods Data of pregnant patients with suspected cervical dysplasia who presented to the University Women’s Hospital Tübingen between 2008 and 2018 were evaluated retrospectively. Colposcopic, cytologic, and histologic assessment was performed for diagnosis. Data on remission, persistence and progression of disease based on histologic and cytologic assessment and the mode of delivery were correlated. Results 142 patients were enrolled. Cytology at first presentation was PAPIII (-p/-g) in 7.0%, PAPIIID (IIID1/IIID2) in 38.7%, PAPIVa (-p/-g) in 50.0%, PAPIVb (-p) in 2.8%, and PAPV (-p) in 1.4%. All cases with suspected invasion were recorded at the initial presentation. Complete histological or cytological remission was observed in 24.4%, partial remission in 10.4%, persistence in 56.3%, and progression in 8.9%. In two cases (1.5%) progression to squamous cell carcinoma occurred. Conclusions Watchful waiting for cervical intraepithelial neoplasia during pregnancy seems to be sufficient and oncologically safe. It is important to exclude invasion during pregnancy, to perform frequent colposcopic, cytologic and histologic examinations and to ensure a postpartum follow-up examination to initiate the treatment of high-grade lesions. Spontaneous delivery seems to be safe in patients with cervical dysplasia, Caesarean section is not indicated.

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Section: Discussioncontrasting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Characterization and clinical management of abnormal cytology findings in pregnant women: a retrospective analysis

Freudenreich

Weiß

Engler

et al. 2022

Arch Gynecol Obstet

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“…There is also a risk of miscarriage or preterm delivery [ 18 ]. Many minor changes will regress after delivery, [ 19 ] those that persist can be treated 4–6 weeks after delivery when the risk of bleeding is less. The aim of colposcopy/screening in pregnancy is therefore to identify precancerous lesions that can be followed up and treated, if necessary, after delivery and also to identify cancerous lesions that require immediate attention.…”

Section: Discussionmentioning

confidence: 99%

Antenatal and postnatal cervical precancer screening to increase coverage: experience from Battor, Ghana

Effah,

Tekpor,

Klutsey

et al. 2023

ecancer

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Background Cervical precancer screening in low-resource settings is largely opportunistic with low coverage. Many women in these settings, where the burden of cervical cancer is highest, only visit health institutions when pregnant or after delivery. We explored screening during antenatal and postnatal visits aimed at increasing coverage. Methods Pregnant women (in any trimester) attending antenatal care (ANC) and women attending postnatal care (PNC; 6–10 weeks) clinics were screened at Catholic Hospital, Battor and at outreach clinics from February to August 2022 (08/02/2022 to 02/08/2022). At the same visit, cervical specimens were obtained for high-risk human papillomavirus (hr-HPV) DNA testing (with the Sansure MA-6000 PCR platform) followed by either visual inspection with acetic acid (VIA) or mobile colposcopy with the enhanced visual assessment system. Results Two hundred and seventy and 107 women were screened in the antenatal and postnatal groups, respectively. The mean ages were 29.4 (SD, 5.4) in the ANC group and 28.6 (SD, 6.4) years in the PNC group. The overall hr-HPV prevalence rate was 25.5% (95% confidence interval (CI), 21.1–29.9) disaggregated as 26.7% (95% CI, 21.4–31.9) in the ANC group and 22.4% (95% CI, 14.5–30.3) in the PNC group ( p = 0.3946). Overall, 58.9% of pregnant women (28.3% hr-HPV+) and 66.4% of postnatal women (22.5% hr-HPV+) only visited a health facility when pregnant or after delivery (at Child Welfare Clinics). The VIA ‘positivity’ rate for all screened women was 5.3% (95% CI, 3.1–7.6), disaggregated into 5.2% (95% CI, 2.5–7.8) in the ANC group and 5.7% (95% CI, 1.3–10.1) in the PNC group ( p -value = 0.853). Conclusion A significant number of women in Ghana only visit a health facility during pregnancy or after delivery. ANC and PNC clinics would offer opportunities to increase coverage in cervical precancer screening in low-resource settings. Relying on community nurses ensures that such programs are readily integrated into routine care of women and no opportunity is missed.

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“…Gomez et al carried out a study to analyse the progression of high-grade CIN through pregnancy as well as the postpartum period [31]. This study also aimed to define factors associated with the regression of dysplasia.…”

Section: The Outcome Of Cervical Premalignant/dysplastic Lesions In T...mentioning

confidence: 99%

The Fate of Cervical Dysplastic Lesions during Pregnancy and the Impact of the Delivery Mode: A Review

Dasgupta¹

2023

Cureus

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Cervical dysplasia, also referred to as cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesion (SIL), is the precursor lesion of cervical carcinoma. Therefore, its diagnosis is vital for early detection and inhibiting the development of cervical carcinogenesis. Human papillomavirus (HPV) is the most common aetiology of cervical cancer and this infection mainly affects young women of childbearing age, thus affecting pregnant women as well. It is essential to know how CIN progresses in pregnant patients because the management of pregnant and non-pregnant patients is different (considering the safety of both mother and child in pregnancy). This review intends to highlight the studies which have assessed the rates of progression of CIN diagnosed in pregnancy throughout the antenatal period and the impact of the mode of delivery on CIN outcomes. We searched PubMed/MEDLINE and Google Scholar databases for relevant articles. Many studies indicate that the rate of progression of these lesions is very slow during the tenure of pregnancy; many also report postpartum regression of these lesions. Thus, in most of these patients, management can be safely implemented in the postpartum period while just keeping them under observation in the antenatal period. However, patients with high-grade CIN have a higher chance of developing invasive cancer and, therefore, require careful monitoring. There is a dispute regarding the role of the mode of delivery in determining the fate of cervical dysplasia. While some studies supported vaginal births over caesarean sections, others did not find any difference between the two in defining the outcome of the dysplastic lesions.

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Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy

Cited by 4 publications

References 27 publications

Characterization and clinical management of abnormal cytology findings in pregnant women: a retrospective analysis

Characterization and clinical management of abnormal cytology findings in pregnant women: a retrospective analysis

Antenatal and postnatal cervical precancer screening to increase coverage: experience from Battor, Ghana

The Fate of Cervical Dysplastic Lesions during Pregnancy and the Impact of the Delivery Mode: A Review

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