Significance of Atypical Cervical Cytology in Pregnancy

Abstract

To ascertain the significance of squamous atypia encountered during routine Papanicolaou smear screening in pregnancy, we reviewed our experience with 76 pregnant women seen during a 4-year period. All were evaluated with repeat cytology and colposcopy during pregnancy and again postpartum. Colposcopic examination during pregnancy revealed a normal transformation zone without evidence of intraepithelial neoplasia in 46 women. In six of these women, repeat cytology was interpreted as cervical intraepithelial neoplasia (CIN) grade 1. In 30 women, an abnormal transformation zone was identified--14 with a negative repeat cytology. In five women, the transformation zone was interpreted as compatible with CIN 2 or CIN 3. Colposcopically directed biopsies were performed in 31 women, in all but two postpartum. Of the 76 women, human papilloma virus or CIN was identified on biopsy in 16 women (21%). We propose that an isolated report of atypical squamous cells on cervical cytology obtained at the initial prenatal visit does not warrant colposcopic evaluation during pregnancy, unless a repeat cytology suggests CIN. Repeat cytology and evaluation to exclude infections and inflammatory lesions is appropriate. However, if a subsequent cytology is abnormal, postpartum colposcopy and colposcopically directed biopsies seem appropriate, since the prevalence of HPV or CIN was 21%.

Cervical Intraepithelial Neoplasia in Jordan: A Ten Year Retrospective Cytoepidemiologic Study

“…18,19 Current evidence points to HPV subtypes as the most important single factor in the etiology of cervical neoplasia 9,14,[20][21][22][23] but one report underplays its role. 11 A previous study in Jordanian females suggested little role of sexually transmitted disease in pelvic inflammatory disease 24 but this does not exclude HPV in the etiology of CIN. Table 1 demonstrates a similar pattern of CIN grades in the two groups but in group 2, lower CIN grades were more frequent, suggesting better awareness in this latter group.…”

“…Absence of CIN in our females who were above 60 is in accordance with other reports in which CIN de novo was either infrequent or absent in females over 50 years of age. 11,12 Frequency of CIN in screened groups within selected patient populations were relatively high; for example, 8% in one California study on emergency ward patients 13 while in another from Seattle, development of CIN at two years was seen in 3% and 28% of HPV negative and positive females respectively. 14 Table 2 shows a stepwise increase of incidence rates in females between the ages of 20 and 49 years with a fall during the sixth decade.…”

Frequency of Cervical Pre-Malignancy in Pregnant Women

“…21% in pre-gnant women is 260. 4 Pregnant women who never have pap smear in last three years were included and following women were excluded. Pregnant women who have negative pap smear in last three years, patients with threatened miscarriage and patients with low lying placenta.…”

“…76 cases of pregnant patients that showed 21% CIN in pap smear samples. 4 Similarly, studies conducted in Pakistan and India screened both obstetrics and gynaecological patients showed up to 5% of cervical epithetlial abnormalities. 5,6 It means that study conducted in antenatal population showed high incidence of CIN as compared to both obstetrics and gynae patients.…”

“…3 In one study conducted in total 76 pregnant females Pap smear were taken and 21 % showed CIN. 4 In another study, conducted at Karachi, Pakistan, cervical smear was taken in 20,995 cervical smears taken in the obstetrics and gynaecological clinics showed 0.71% atypia. 5 Another study conducted in India in which 300 pap smears were taken from patients who attended obstetrics and gynaecology showed cervical epithelial abnormalities in 5% of cases.…”