Colposcopy is mandatory when a significant abnormal pap smear is indicated in pregnant patient. The main purpose of Colposcopy during pregnancy is to rule out invasive cervical cancer. But one has to remember that this procedure is more difficult in pregnancy due to the physiologic changes: Hyper vascularization and congestion, cervical mucus, redundant vaginal walls, metaplasia, decidual changes. Inflammation, exaggeration of patterns and abnormal vascularisation are the most difficult evaluation for colposcopists, especially decidual “lesions”. In order to avoid unnecessary colposcopic evaluation, the Society of Canadian Colposcopists (SCC) recommend: “Women with an ASC-US or LSIL test result during pregnancy should have repeat cytology testing at 3 months post pregnancy, rather than colposcopy”, “Patients with CIN2+, ASC-H or AGC should be referred for colposcopy within 4 weeks”, and endocervical curettage (SCC) should not be performed during pregnancy. When a CIN2+ is suspected, a biopsy is indicated. If the biopsy confirms a HSIL, a treatment is delayed 2 to 4 months after delivery. When an invasive cancer is suspected after a biopsy, a “partial” conisation can be done. In summary: Colposcopy is more difficult, so do not hesitate to ask for an expert consultation, a biopsy is not always necessary, if a « cone » is indicated, do a « directed excision ».
Above
Above
Above
None