Colposcopic changes in the cervix during normal pregnancy and puerperium

Abstract

Background: Cervical cancer is one of the most important preventable malignancies in women. Incidence of cervical cancer in pregnant women is same as in non-pregnant women. Colposcopy is an important tool to confirm cervical lesion in the setting of abnormal Pap smear. A number of physiological changes occurring in pregnancy make interpretation of colposcopy difficult during pregnancy. Knowledge of normal is essential before interpretation the abnormal. Subjects and Methods: With this aim colposcopy was done in 50 normal pregnant and post-partum women. Results: Mean age was 25 years; there was an equitable distribution among all trimesters and puerperium. Per speculum changes were seen in 72% patients, most common were congestion (34%) and papillary lesions (30%). Colposcopic examination was adequate in 96% cases. Acetowhite lesions were seen in 76%, most were mild intensity (69%). With advancing gestation their size increased. Partial uptake of iodine was seen in 12% patients. Vascular pattern changes were seen in 52% patients, most (80%) were coarse vessels. Overall 66% patients had normal colposcopy, 10% had erosions, 16% had CIN 1 and 8% had CIN 2 lesions. Pap smear correlation was seen in only 60% patients. In first trimester cervix showed congestion, papillary lesions, mildly intense, limited area acetowhite lesions, partial uptake of iodine and coarse punctuate vascular pattern. In second trimester cervix showed maximum congestion, acetowhite areas increased in intensity and area of distribution, and vascular pattern showed fine vessels and coarse punctuate and mosaic vessels. In third trimester cervical changes were similar to second trimester but aceto-white areas further increased in intensity and size, and vascular changes were more marked. In puerperium the congestive changes disappeared, only papillary lesions remained, acetowhite areas decreased in intensity and were all mildly intense; their size also reduced. Vascular changes also reverted back to those present in first trimester. Conclusion: Colposcopy is safe and feasible in pregnancy and puerperium. Colposcopy changes in pregnancy and puerperium are varied and protean but show definite patterns with period of gestation. Abnormal colposcopic findings can be elucidated with ease once different pattern recognition skill as required during pregnancy is acquired. Pap smear shows poor correlation during pregnancy.