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med:abnormal_cervical_cytology_in_pregnancy [2015/05/14 11:15] – [PAP] V_Lmed:abnormal_cervical_cytology_in_pregnancy [2024/04/24 17:38] (현재) – 172.68.119.58
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-====== Abnormal Cervical Cytology In Pregnancy ======+{{tag>의학 ascus abnormal cervical cytology pregnancy}} 
 +====== 임신 중 비정상 자궁세포검사 ======
  
 Abnormal cervical cytology in pregnancy Abnormal cervical cytology in pregnancy
줄 5: 줄 6:
 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 — 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===+=====PAP=====
 |ASC-US | 분만 후 재검| |ASC-US | 분만 후 재검|
-|LSIL |분만 후 재검 혹은 분만전 확대경 and/or 조직검사((CIN 2 or 3 혹은 암 의심시))| +|LSIL |분만 후 재검 (Acceptable) 혹은 분만전 확대경 (Preferred)  and/or 조직검사((CIN 2 or 3 혹은 암 의심시))| 
-|ASC-H, HSIL |분만전 확대경 and/or 조직검사((CIN 2 or 3 혹은 암 의심시))|+|ASC-H,AGC, HSIL |분만전 확대경 and/or 조직검사((CIN 2 or 3 혹은 암 의심시))|
  
   *  The rate of CIN 2,3 is only 3.7 percent on postpartum follow-up for women with prenatal ASC-US or LSIL.    *  The rate of CIN 2,3 is only 3.7 percent on postpartum follow-up for women with prenatal ASC-US or LSIL. 
-  *  +====ASC-US==== 
-===Punch Biopsy=== +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.  
-|CIN I| 분만 후 재검| + 
-|CIN II,III| 분만 후 재검 혹은 3-4개월 간격 확대경 & PAP|+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. 
 + 
 +=====Punch Biopsy===== 
 +|CIN I|분만 후 재검| 
 +|CIN II,III|3-4개월 간격 확대경 & PAP|
  
  
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 the Pap smear should be repeated 3 months postpartum. the Pap smear should be repeated 3 months postpartum.
 This practice is safe as the rate of cancer in this group is This practice is safe as the rate of cancer in this group is
-very low.36 If HSIL, ASC-H, or AGC is found, prompt+very low. 
 + 
 +If HSIL, ASC-H, or AGC is found, prompt
 evaluation with colposcopy is essential. If colposcopy is evaluation with colposcopy is essential. If colposcopy is
 unsatisfactory in the first trimester, it should be repeated unsatisfactory in the first trimester, it should be repeated
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 changes, the cervix everts itself and the squamocolumnar changes, the cervix everts itself and the squamocolumnar
 junction may become visible. junction may become visible.
-If CIN 3 or carcinoma is suspected, biopsy is recommended. 
-There is evidence that biopsy in pregnancy is not harmful.37 
-Women with high-grade dysplasia in pregnancy should be 
-seen by an experienced colposcopist. 
-Recommendations 
-21. Women with an ASC-US or LSIL test result during 
-pregnancy should have repeat cytology testing at 
-3 months post pregnancy. (III-B) 
-22. Pregnant women with HSIL, ASC-H, or 
-AGC should be referred for colposcopy within 
-4 weeks. (III-B) 
-23. Endocervical curettage should not be performed 
-during pregnancy. (III-D) 
  
 +=====확대경검사=====
 +CIN 3 이나 암이 의심되는 경우에는 조직검사를 시행한다((If CIN 3 or carcinoma is suspected, biopsy is recommended))
 +임신 중 조직검사는 해롭지 않다는 증거가 있다. 
  
-=====ASC-US===== +고등급이형성증이 있는 산모는 반드시 경험 있는 부인과의사가 진료하도록 한다.
-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.+저등급(LSIL)이나 ASC-US 인 경우 3개월 후에 세포검사를 다시 시행한다.  
 + 
 + 
 +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-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). 
  
-=====LSIL===== 
  
-Colposcopy is recommended for pregnant women with LSIL, similar to non-pregnant women. Management after colposcopy depends upon what the biopsy shows. 
  
  
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 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**. 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=====
 +
 +  * [[http://unmfm.pbworks.com/w/file/fetch/81124142/abnormalpap-Preg.pdf|참고]]
   * http://www.aafp.org/afp/2009/0715/p147.html   * http://www.aafp.org/afp/2009/0715/p147.html
 +  * http://www.asccp.org/Guidelines
 +
  
-{{tag>의학 ascus abnormal cervical cytology pregnancy}}