The management of patients with abnormal pap smear in pregnancy is a challenge for gynaecologists. It is therefore recommended to send these women to a Dysplasia Clinic for further diagnostic procedures. 1- 7% of all pregnant women are diagnosed with an abnormal pap smear during the first visit of pregnancy. The aim is to guarantee the health of the mother on the one hand side and the prolongation of the pregnancy on the other hand side. Aim of this study was to investigate the outcome of pregnant women diagnosed and treated for abnormal pap smear at the dysplasia clinic of the University Hospital in Duesseldorf, Germany.
In this study we evaluated retrospectively the data of 102 patients visiting our dysplasia clinic from 2010 to 2015 in respect to cytology (Münchner NomenklaturII/III and Bethesda), HPV-infection status, colposcopy, histology, way of delivery and findings after delivery.
The median age was 30.6 years; the mean age of gestation at first visit was 17.7 weeks. 39.2 % presented with PAPIIID (LSIL), 53.9 % with PAP IVa (HSIL), 1.9 % with PAP IIp (ASC-US), 2.9 % with PAP IIIp/g (ASC-H, AGC) and 0.98% with PAP IV b (HSIL with features suspicious for invasion). In 82 patients we diagnosed a major change lesion on colposcopy; in 46 cases we performed a biopsy to exclude invasion. In 39 cases histology confirmed a CIN3, in 6 cases the histological diagnosis was CIN1 or 2, one patient was diagnosed with microinvasive cervical cancer. 24.5 % were delivered via caesarean section (for other reasons than dysplasia), 75.5 % had a vaginal delivery. After delivery 58.2% received a LEEP because of persistence of CIN 3. During follow up visit after delivery 46.1 % showed regression, 51 % persistence of the dysplasia and 2.9 % had progressive disease. None showed a progression to invasive carcinoma.
These results support the recommendation of the guidelines of conservative management of abnormal pap smear in pregnancy. From our point of view a more invasive investigation such as a conisation is generally not recommended.