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.
|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)|
|CIN I||분만 후 재검|
|CIN II,III||3-4개월 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)
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.
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
Colposcopy is recommended for pregnant women with LSIL, similar to non-pregnant women. Management after colposcopy depends upon what the biopsy shows.
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.