Management of abnormal results of the cervical screening during pregnancy

Abstract

Nowadays, it has been registered an increased trend of detection for gynecological malignancies during pregnancy, mostly due to increased maternal age, cervical cancer being the most frequent malignancy in pregnancy. About 3% of the cervical cancer cases are diagnosed during pregnancy. The clinical manifestations depend of the stage and the lesion size, ranging from complete asymptomatic to vaginal bleeding or discharge, pelvic pain and chronic anemia. The screening of cervical cancer during pregnancy does not differ from the one of the nonpregnant patient, and should include cervical cytology and HPV testing, according to the national health policy. For selected cases, colposcopy and cervical biopsy can be performed in order to exclude the invasion. Given the physiological changes that occur to the cervix during the gestational period, the examination of the Pap smears and the colposcopies should be done by experienced physicians. Endometrial biopsy, endocervical curettage and the excisional treatment without biopsy are forbidden during pregnancy. The indications of cervical conization are limited for high-grade squamous intraepithelial lesions (HSIL) with unsatisfactory colposcopy and for those with suspicion or evidence of invasive disease. Otherwise, the procedure should be postponed until the postpartum period. Regarding the natural history of cervical intraepithelial neoplasia (CIN) during pregnancy, it has been shown that most of the lesions remain stable during pregnancy, but only a small rate (less than 5% of cases) have a more aggressive evolution, therefore it is important to have an adequate follow-up and management.