Postpartum Evolution of Cervical Squamous Intraepithelial Lesions With Respect to the Route of Delivery

Abstract

A review of the patient files of the Northwestern Memorial Hospital Colposcopy Clinic for the years 1990 through 1998 identified 326 women who presented during pregnancy for evaluation of abnormal cervical smear results and who met the study criteria of complete clinical information and postpartum follow-up within 1 year. These patients were investigated for the evolution of abnormal cervical conditions throughout pregnancy and the postpartum period, including impact of the route of delivery. The women ranged from 13 to 44 years of age (mean, 24 years). Three hundred women delivered vaginally, and 26 had a cesarean, 6 of which were elective. Minimally abnormal smears, which included atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL), were seen in 249 (76.3%) patients (24 with ASCUS and 225 with LSIL). High-grade squamous intraepithelial lesions (HSIL) were seen in 77 (23.6%) patients. Three women had glandular abnormalities. One of these women was also diagnosed with ASCUS, and one woman was found to have adenocarcinoma in the cervical smear obtained at colposcopy. She was treated with cone biopsy in the first trimester and had no glandular changes in postpartum evaluation. She was the only patient in this series with cervical cancer. At the first postpartum visit, 20 patients had surgical evaluation with cone biopsy, colposcopy, and biopsy, and 1 woman had hysterectomy. In the remaining 306 patients, 248 had ASCUS or LSIL, and 58 had HSIL. No change in cervical smear was seen in the antepartum and postpartum diagnoses of 116 women (37.9%), and improved results were seen in 180 (58.8%). Of the 248 women who initially had minimally abnormal results, 10 (4%) had a worse diagnosis after delivery, 144 (58.2%) had an improved diagnosis, and 94 (37.9%) had no change in the postpartum cervical smear. None of the 58 women with antepartum HSIL had worse results postpartum, 36 (62.1%) had improved results, and 22 (37.9%) experienced no change in the postpartum evaluation. In bivariate analyses of antepartum patient characteristics, including patient age, antepartum cytology, and route of delivery, the only significant difference between ASCUS/LSIL and HSIL was patient age. Women with HSIL were significantly older than women with minimal cervical abnormalities (26.8 vs. 23.2 years; P = .003). Postpartum results were not influenced by route of delivery. Disease regression was seen in 57.5% of women who had vaginal delivery and 76.2% of women who had cesarean delivery (P = .81).