Association Between Mode of Delivery and Postpartum Assessment of High-Grade Cervical Dysplasia Diagnosed in Pregnancy [ID 2683564

Abstract

INTRODUCTION: Approximately 5% of pregnancies are complicated by cervical dysplasia. It is hypothesized that cervical remodeling during vaginal delivery may confer higher rates of postpartum regression when compared to cesarean. We sought to evaluate the relationship between mode of delivery and postpartum dysplasia outcomes. METHODS: This is a retrospective cohort study of patients with biopsy-proven high-grade dysplasia diagnosed during pregnancy from January 2013 to December 2022. Demographics, obstetric outcomes, and antepartum and postpartum cervical pathology were collected and IRB approval obtained. Only immunocompetent patients with postpartum pathology obtained within 1 year of delivery were included. Definitions based on postpartum pathology were as follows: regression as low-grade or resolved dysplasia, persistence as high-grade dysplasia, and progression as cervical cancer. Rates were stratified by mode of delivery and data analyzed using the chi-squared test. RESULTS: Among our cohort (N=286), 101 (35%) were diagnosed with CIN2, 181 (63%) with CIN3/CIS, and 4 (1%) with HSIL (not otherwise specified) on antepartum cervical biopsy. 228 (80%) delivered via vaginal delivery and 58 (20%) delivered via cesarean. Rate of postpartum regression was similar in both delivery groups (37% versus 38%; P=.927), as was persistence (62% versus 60%; P=.786). Rate of apparent progression to invasive cancer was low in both groups (<1% versus 2%; P=.365). CONCLUSION: High rates of persistence and low rates of apparent progression were observed subsequent to both vaginal and cesarean deliveries. Our data indicate that the natural history of high-grade dysplasia diagnosed during pregnancy is not affected by route of delivery in a way that should influence postpartum management.