Screening for Cervical Cancer in Pregnancy-Our Experience

Abstract

Objective: • To diagnose Cervical intraepithelial neoplasia in pregnancy with Visual Inspection of cervix with Acetic acid and Lugol`s Iodine and Papsmear as screening tool. • To assess the difficulties of screening and colposcopy in pregnancy. Design: Retrospective study Materials and Method: 350 antenatal women less than 20 weeks of gestational age attending the OG OPD at PSG Hospitals, Coimbatore were subjected to visual inspection of cervix with Acetic acid and Lugol's iodine and Pap smear. A Pap smear was taken from all pregnant women following which visual inspection of cervix with Acetic acid and Lugol's iodine were done by applying 5% Acetic acid followed by Lugol's iodine. If there was an abnormality on visual inspection of cervix with Acetic acid and Lugol's iodine or cytology patients were recalled for colposcopy. Results: 350 pregnant women both primigravidae and multigravidae were screened (n=350). Among them the screen positives for visual inspection of cervix with Acetic acid and Lugol's Iodine=30 (8.57%). Three patients had abnormal results on Pap smear (0.8%), (2 had HSIL, 1 had LSIL). Of the 30 patients who were recalled for colposcopy, 4 (13.3%) were abnormal (CIN I=2, CIN II&CIN III=2). Conclusion: Though visual inspection of cervix with Acetic acid and Lugol's iodine has high false positivity rate because of physiological changes in pregnancy, it is still a feasible screening method in a low resource setting like ours. In our study, we had 4 positives and all of them were picked up by visual inspection of cervix with Acetic acid and Lugol's iodine. So screening for cervical cancer during pregnancy is worthwhile as antenatal clinic may be the only opportunity.