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.

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).

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

• 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.

• Medscape: Ascus