The aim of the study was to analyze the regression, persistance and progression of cervical intraepithelial neoplasia first diagnosed during pregnancy, in order to assess the suitable management of such lesions for the pre- and postpartal period.
In the course of this study the cases of 138 pregnant women who presented with pathological cervical findings at the Dysplasia Clinic of the University Medical Center Hamburg Eppendorf between the years of 2011 and 2017 were retrospectively analyzed. Differential colposcopy, a cytology, a biopsy and as appropriate a HPV test were performed on all patients. In the case of CIN diagnosis regular follow-ups were carried out. The initial histopathological findings were compared to those of the postpartal period.
A total of 138 pregnant women of the median age of 31 years (range 19-41) with colposcopic evidence of cervical dysplasia (n=15) or suspicious cytology (n=53 with PAP IIID, n= 70 with PAP IVa/b) were included. On average the patients first presented in the 17th (range 5-31) week of pregnancy and were followed-up every 8 weeks. No progression to carcinoma was diagnosed in any of our patients and no woman had to be subjected to a conisation during the course of pregnancy. 60 patients with initial CIN diagnosis during pregnancy were presented for a scheduled postpartal exam, where 16.7% (n=10) showed a partial regression of CIN, while 40% (n=24) showed a complete regression of CIN. 33.3% (n=20) were diagnosed with persistent findings of CIN. In 10% (n=6) of cases progression to severer CIN not however to a carcinoma had occurred. All in total 34 patients were operated on postpartally by conisation and endocervical currettage.
CIN lesions during pregnancy have a prepartal slight progression and postpartal a higher tendency for regression. After the exclusion of an invasive procedure, the definitive treatment can be postponed with little risk to the postpartal period. The necessity of a check-up every 8 weeks after the dectection of a high-grade lesion (CIN 2-3) during pregnancy can not be deduced/inferred from these findings.