The effect of route of delivery on regression of abnormal cervical cytologic findings in the postpartum period

Ahdoot, David; Nostrand, Kristi M. Van; Nguyen, Nicole J.; Tewari, Devansu; Kurasaki, Tom; DiSaia, Philip J.; Rose, G. Scott

doi:10.1016/s0002-9378(98)70310-2

Cited by 70 publications

(58 citation statements)

References 8 publications

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“…This downward trend in high-risk HPV prevalence postpartum may be explained by cervical trauma occurring at the time of delivery with additional repair of the cervical epithelium (Yost et al, 1999). Indeed, in a study in which postpartum regression rates of cervical lesions were Molecular and Cellular Pathology compared in women who delivered vaginally or by caesarean section, a higher postpartum regression was seen in women with vaginal deliveries probably due to stimulation of local immune factors (Ahdoot et al, 1998). From recent studies we know that HPV clearance is associated with and precedes on average 3 months regression of cervical lesions (Nobbenhuis et al, 2001;Zielinski et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

et al. 2002

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We followed 353 women referred with abnormal cervical cytology in a non-intervention cohort study. In 91 pregnant women we compared high-risk human papilloma virus rates in the subsequent trimesters and postpartum in comparison to 262 nonpregnant women. High-risk human papilloma virus clearance was compared with 179 high-risk human papilloma virus positive non-pregnant women. Our main questions were: (1) do high-risk human papilloma virus rates change during pregnancy?; and (2) is there any difference between high-risk human papilloma virus clearance in pregnant and non-pregnant women? Women were monitored 3 -4 monthly by cytology, colposcopy, and high-risk human papilloma virus testing. The median follow-up time was 33 months (range 3 -74). Non-pregnant women showed prevalence rates of high-risk human papilloma virus of 64, 57, 53, and 50%, respectively, in four subsequent 3-months periods since the start of the study. These high-risk human papilloma virus rates were higher than in the three trimesters of pregnancy, and during the first 3 months postpartum, i.e. 50, 44, 45, and 31%, respectively. Postpartum only, this difference was statistically significant (P=0.004). Paired comparisons of high-risk human papilloma virus prevalence rates of the different trimesters with the postpartum rate showed (McNemar test) decreased rates: first trimester: 18% (P=0.02), second trimester: 13% (P=0.02) and third trimester: 23% (P50.005). Such a phenomenon was not found in non-pregnant women. Pregnant women showed a trend for increased high-risk human papilloma virus clearance during the third trimester and postpartum compared to non-pregnant women (hazard ratios 3.3 (0.8 -13.7) and 4.6 (1.6 -12.8), respectively). These results suggest a lowered immune-response against human papilloma virus during the first two trimesters of pregnancy with a catch-up postpartum. Keywords: human papillomavirus; pregnancy; follow-up study; natural history; prevalence Several epidemiological and biological studies have established the important role of infection with high-risk types of human papilloma virus (HPV) for development of cervical cancer and its precursor lesions. In women with or without abnormal cervical smears a positive high-risk HPV test result indicates an increased risk for development of high grade cervical lesions (Ho et al, 1995;Remmink et al, 1995;Rozendaal et al, 1996Rozendaal et al, , 2000Nobbenhuis et al, 1999). Moreover, in nearly all cervical cancers high-risk HPV types have been detected .The increased prevalence of high grade cervical lesions and cervical cancer in immunocompromised patients, such as AIDS patients and transplant recipients, indicates that persistence of high-risk HPV and consequently HPV-mediated carcinogenesis is related to compromised immunosurveillance (IARC, 1995;Petry et al, 1996;Sun et al, 1997). Pregnancy is believed to alter immune-response in women (Schneider et al, 1987;Sethi et al, 1998). Some authors concluded pregnancy has no effect on CIN (Jain et al, 1997). Others reported high regress...

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Section: Discussionmentioning

confidence: 99%

High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

et al. 2002

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“…In Maiduguri, Northern Nigeria, the prevalence of 7.8% was obtained following review of Pap smear over 15-year period amongst women attending gynaecologic clinic [10]. The prevalence of pap-smear reported in the developed world is between 0.5% -3% [11] [12] [13] [14]. However, reports from Turkey and Brazil had lower prevalence rate of 0.9% and 1.9% respectively [5].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Pattern of Abnormal Pap Smear among Pregnant Women Attending Antenatal Clinic in a Missionary Hospital in Abakaliki, Southeast Nigeria

Ekwedigwe¹,

Ezeonu²,

Edegbe³

et al. 2018

OJOG

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BACKGROUND: Cervical cancer is the most common type of cancer affecting the genital tract among women in developing countries. Screening programmes have been well talked about in Nigeria, but they are not well organized. Hence, the incidence of cervical cancer does not appear to be reducing. A possible way of solving this problem is by doing an opportunistic pap smear among women attending antenatal clinics, since a good number of women do access antenatal care. OBJECTIVES: To determine the prevalence, knowledge, awareness, practice, risk factors and pattern of Pap smear among women attending antenatal clinic in Mile 4 hospital, Abakaliki. METHOD: This is a cross-sectional study carried out at the antenatal clinic of Mile 4 Hospital, Abakaliki, Nigeria. A total of 110 consecutive pregnant women who fulfilled the inclusion criteria and have given their consent were recruited into the study at the time of their first prenatal (booking clinic) visit for antenatal care. Data was collected using a questionnaire. Conventional Papanicolaou smear was taken using the standard procedure. The cytopathologic findings were documented in the questionnaire. RESULTS: Out of the 110 pregnant women who had cervical cytology by Pap smear, 7 had pre-invasive cervical lesion, giving a prevalence rate of 6.3%; 5 (71.4%) were low-grade squamous intraepithelial lesion (LGSIL) while 2 (28.6%) were high-grade squamous intraepithelial lesion (HGSIL). Fifty women (45.5%) had negative smears. Inflammatory smears were seen in 50 women (45.5%). Insufficient smear was seen in 3 women (2.7%). Fifty-six women had knowledge about cervical canHow to cite this paper: Ekwedigwe, K.C., Ezeonu, P.O., Edegbe, F., Esike, C., Agbata, A.T., Ukaegbe, C. cer (50.9%), while thirty-six women (32.7%) were aware of a screening program for cervical cancer and only 2 women (1.8%) had been screened in the past. Hence, from this study, the population screening rate was approximately 2%. The risk factors were age of coitarche <15 years, number of sexual partners, previous history of sexual transmitted infection, genital warts, human immune deficiency virus and use of contraceptives. CONCLUSION: The pap-smear findings among pregnant women in Abakaliki, Nigeria showed that the pre-invasive lesion of the cervix is relatively common. Pap smear should be made routine for all pregnant women.

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“…According to the worldwide literature, HGSIL type changes undergo spontaneous regression during confinement depending on the publication from 48 to 70% [10,11].…”

Section: Discussionmentioning

confidence: 99%

The incidence of cervical intraepithelial neoplasia in a population of pregnant women with an abnormal cytology

Pruski¹,

Malkowska-Walczak

Paluszkiewicz

et al. 2017

Ginekol Pol

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Objectives: To assess the incidence of cervical intraepithelial neoplasia -SIL and cervical cancer in a population of pregnant women with an abnormal cytology. Material and methods:In pregnant women with abnormal cytology results according to The Bethesda System, a verifying diagnostics was carried out, including colposcopy and cervical biopsy. Results:The most common histological and oncologic diagnosis in the whole study group of pregnant women were HGSIL changes, covering cervical intraepithelial neoplasia of medium and high grade -CIN 2 and CIN 3.Conclusions: HGSIL changes are the most common oncological pathology in a population of pregnant women with an abnormal cytology. Precise risk identification of HGSIL changes with the use of molecular tests can significantly reduce the number of surgical procedures in a population of pregnant patients with a cytological diagnosis of ASCUS and LSIL.

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The effect of route of delivery on regression of abnormal cervical cytologic findings in the postpartum period

Cited by 70 publications

References 8 publications

High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

Prevalence and Pattern of Abnormal Pap Smear among Pregnant Women Attending Antenatal Clinic in a Missionary Hospital in Abakaliki, Southeast Nigeria

The incidence of cervical intraepithelial neoplasia in a population of pregnant women with an abnormal cytology

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