임신 중 비정상 자궁세포검사

Abnormal cervical cytology in pregnancy

Pregnant women — The evaluation and management of pregnant women is different from non-pregnant women because of the risk that trauma to the cervix could lead to preterm labor or delivery.

PAP

ASC-US 분만 후 재검
LSIL 분만 후 재검 (Acceptable) 혹은 분만전 확대경 (Preferred) and/or 조직검사1)
ASC-H,AGC, HSIL 분만전 확대경 and/or 조직검사2)
  • The rate of CIN 2,3 is only 3.7 percent on postpartum follow-up for women with prenatal ASC-US or LSIL.

Punch Biopsy

CIN I분만 후 재검
CIN II,III3-4개월 간격 확대경 & PAP

The indications for colposcopy in pregnant women are essentially the same as in non-pregnant women. If a lowgrade lesion (ASCUS or LSIL) is found during pregnancy, the Pap smear should be repeated 3 months postpartum. This practice is safe as the rate of cancer in this group is very low.

If HSIL, ASC-H, or AGC is found, prompt evaluation with colposcopy is essential. If colposcopy is unsatisfactory in the first trimester, it should be repeated after 20 weeks’ gestation when, because of the physiological changes, the cervix everts itself and the squamocolumnar junction may become visible.

If CIN 3 or carcinoma is suspected, biopsy is recommended.

There is evidence that biopsy in pregnancy is not harmful.

Women with high-grade dysplasia in pregnancy should be seen by an experienced colposcopist.

Women with an ASC-US or LSIL test result during pregnancy should have repeat cytology testing at 3 months post pregnancy. (III-B)

Pregnant women with HSIL, ASC-H, or AGC should be referred for colposcopy within 4 weeks. (III-B)

Endocervical curettage should not be performed during pregnancy. (III-D)

ASC-US

Pregnant women with ASC-US and a positive HPV test may elect to have Colposcopy during pregnancy or wait until at least six weeks after delivering their baby.

The reason for this recommendation is that cervix appears somewhat different during pregnancy, which can make it difficult to determine if an area appears abnormal due to pregnancy or due to precancerous changes. In addition, most mild abnormalities resolve over time without treatment.

ASC-H

Pregnant women with ASC-H should have a colposcopy. This is because ASC-H is more likely than ASC-US to be caused by a precancerous change. Management after colposcopy depends upon the result of the biopsy (see below).

5 year cancer rate 2%

CIN3+ risk is between LGSIL and HGSIL

LSIL

Colposcopy is recommended for pregnant women with LSIL, similar to non-pregnant women. Management after colposcopy depends upon what the biopsy shows.

Management after colposcopy

  • CIN 1 — Pregnant women with CIN 1 are usually advised to defer further evaluation and treatment until at least 6 weeks after delivery of the baby. The reason for this recommendation is that most mild abnormalities will resolve over time without treatment.
  • CIN 2 or 3 — If there is evidence of CIN 2 or 3, colposcopy and cervical cytology testing may be done every 3 to 4 months during the pregnancy, or further evaluation may be deferred until at least 6 weeks after the woman delivers her baby. Treatment to remove the abnormal area is not recommended during pregnancy.

The reason for this recommendation is that CIN 2 or 3 is caused by precancerous changes that have the potential to become cancerous when untreated. This is a slow process that takes many months to years. As long as the abnormality is monitored, it is not necessary to remove the area (and increase the risk of preterm delivery or miscarriage) until after delivery.

참고

1) , 2)
CIN 2 or 3 혹은 암 의심시

연결문서

CC Attribution-Noncommercial-Share Alike 4.0 International 별도로 명시하지 않을 경우, 이 위키의 내용은 다음 라이선스에 따라 사용할 수 있습니다: CC Attribution-Noncommercial-Share Alike 4.0 International
4 KB med/abnormal_cervical_cytology_in_pregnancy.txt · 마지막으로 수정됨 2018/03/15 09:15 저자 V_L V_L

0.045 seconds in processing this page on this powerful server.