Colposcopic Examination in Pregnancy
Cervical intrepithelial neoplasia (CIN) is the most common preinvasive lesion seen in women during pregnancy. It is found in 0.19 %–0.53 % of pregnant women, but cervical carcinoma is rare. Physiological and anatomical changes in cervix which are associat
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Sumita Mehta and Anshuja Singla
Cervical cancer is the most commonly diagnosed gynecological malignancy during pregnancy with an incidence of 0.5–12/10,000 pregnancies. Pregnancy does not increase the risk for cervical dysplasia or neoplasia with abnormal cytology being seen in 1.26–2.2 % of pregnant women. Histologically diagnosed cervical intraepithelial neoplasia (CIN) is found in 0.19–0.53 % of pregnant women, but cervical carcinoma is rare [1, 2]. Pregnancy also has no effect on progression or prognosis of cervical cancer.
13.1
Cervix and Pregnancy
Pregnancy alters the anatomical, physiologic, cytologic, and histologic milieu of the cervix, thereby changing the colposcopic interpretation. The changes in the cervix during pregnancy have been discussed in detail in Chap. 3. The colposcopist has to have the required expertise and an eye for detecting the difference between the normal and abnormal changes in the pregnant cervix.
13.2
Aims of Colposcopy During Pregnancy
1. To exclude invasive disease 2. To defer biopsy or treatment until the woman has delivered
S. Mehta (*) Babu Jagjivan Ram Memorial Hospital, Delhi, India e-mail: [email protected] A. Singla Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India © Springer Science+Business Media Singapore 2017 S. Mehta, P. Sachdeva (eds.), Colposcopy of Female Genital Tract, DOI 10.1007/978-981-10-1705-6_13
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S. Mehta and A. Singla
The safety of delaying treatment of pregnant women has been shown in a number of cohort and retrospective uncontrolled studies [3–5]. The incidence of invasive cervical cancer in pregnancy is low, and pregnancy itself has no adverse effect on the prognosis. Of the dysplasia cases diagnosed in pregnancy, 10–70 % regress, persistence of severity is seen in 25–47 %, and progression is reported in only 3–30 % [6].
13.3
Indications for Colposcopy in Pregnancy
The indications for colposcopy in pregnant women are similar to the ones in nonpregnant women: • Women with cervical abnormalities suggestive of high-grade squamous lesions (to exclude invasive disease). • All glandular lesions on cytology. • Persistent postcoital bleeding or suspicious-looking cervix. A woman with unexplained persistent bleeding in pregnancy especially postcoital should have a speculum examination, cytology, and colposcopy [7]. The recommendations of SOGC Joint Clinical Practice Guideline (2012) of managing abnormal cytology in pregnancy are [8]: 1. Women with ASC-US or LSIL test should have repeat cytology testing at 3 months postpartum. This practice is safe as the rate of cancer in this group is low [9]. 2. Pregnant women with HSIL, ASC-H, or AGC should be referred for colposcopy within 4 weeks.
13.4
Normal Colposcopic Changes in Pregnancy
The colposcopic appearance of the cervix changes dramatically throughout pregnancy. The most important changes seen are shown in Table 13.1
13.4.1 Increased Vascularity of the Cervix (Figs. 13.1 and 13.2) Increased vascularity of the
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