Abstract
Objective: The aim of this study was to describe the evolution of high-grade cervical dysplasia during pregnancy and the postpartum period and to determine factors associated with dysplasia regression. Methods: Pregnant patients diagnosed with high-grade lesions were identified in our tertiary hospital center. High-grade lesions were defined either cytologically, by high squamous intraepithelial lesion/atypical squamous cells being unable to exclude HSIL (HSIL/ASC-H), or histologically, with cervical intraepithelial neoplasia (CIN) 2+ (all CIN 2 and CIN 3) during pregnancy. Postpartum regression was defined cytologically or histologically by at least a one-degree reduction in severity from the antepartum diagnosis. A logistic regression model was applied to determine independent predictive factors for high-grade cervical dysplasia regression after delivery. Results: Between January 2000 and October 2017, 79 patients fulfilled the inclusion criteria and were analyzed. High-grade cervical lesions were diagnosed by cytology in 87% of cases (69/79) and confirmed by histology in 45% of those (31/69). The overall regression rate in our cohort was 43% (34/79). Univariate analysis revealed that parity (p = 0.04), diabetes (p = 0.04) and third trimester cytology (p = 0.009) were associated with dysplasia regression. Nulliparity (OR = 4.35; 95%CI = (1.03–18.42); p= 0.046) was identified by multivariate analysis as an independent predictive factor of high-grade dysplasia regression. The presence of HSIL on third-trimester cervical cytology (OR = 0.17; 95%CI = (0.04–0.72); p = 0.016) was identified as an independent predictive factor of high-grade dysplasia persistence at postpartum. Conclusion: Our regression rate was high, at 43%, for high-grade cervical lesions postpartum. Parity status may have an impact on dysplasia regression during pregnancy. A cervical cytology should be performed at the third trimester to identify patients at risk of CIN persistence after delivery. However, larger cohorts are required to confirm these results.
Highlights
In current obstetrical practice, antenatal consultations are commonly considered as an opportunity to screen for cervical cancer
Human papilloma virus (HPV) infections appear to be more frequent among pregnant women, which may be related to the immunotolerance observed in pregnancy [7,8]
Nulliparity (OR = 4.35; 95% confidence intervals (95%CIs)= (1.03–18.42); p= 0.046) and presence of HSIL at third-trimester cervical cytology (OR = 0.17; 95%CI = (0.04–0.72); p = 0.016) were identified as independent predictive factors for dysplasia regression (Table 5)
Summary
Antenatal consultations are commonly considered as an opportunity to screen for cervical cancer. High-grade dysplasia is most frequently diagnosed during the childbearing years, with an incidence of 8.1/1000 women aged 25–29 years [1]. Cervical intraepithelial neoplasia (CIN) is diagnosed in 1–7% of pregnant women [2,3], among whom the prevalence of high-grade lesions (defined as CIN2+) is 0.5% [4]. According to international criteria [9], pregnant patients with cytological abnormalities should be investigated by colposcopy in order to exclude a cancer by targeted biopsy. Assessment of the cervix in pregnancy may be complicated due to pelvic congestion, colposcopic criteria remain the same as for non-pregnant women. Colposcopy, and targeted biopsies are as reliable during pregnancy as for non-pregnant-women [10]
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