Course of high-grade cervical intraepithelial neoplasia diagnosed during pregnancy
20 September 2018 (online)
Management of high grade cervical intraepithelial neoplasia diagnosed during pregnancy is controversial. Currently close monitoring including colposcopy and cytology every 8 weeks is recommended.
All pregnant women who presented with abnormal cytology at the University Medical Center Hamburg-Eppendorf from 2011 – 2017 were analyzed retrospectively.
A total of 139 pregnant women at a median age of 31 years (range 19 – 49) and abnormal cytological findings (≥Pap II) were identified. At least one prepartal biopsy was performed on 98 (70.5%) patients. 7 (7.1%) were diagnosed with CIN1, 14 (14.3%) with CIN2 and 69 (70.4%) with CIN3, whereas in 8 (8.2%) cases no dysplasia was detected. 90/139 (64.7%) were seen for postpartum follow-up (FU). Despite explicit invitation only 50/69 (72.5%) women with prepartally diagnosed CIN3 attended a postpartal FU with histology (range birth to 1st FU: 40 – 183 days, median 62). 25/50 (50%) presented with a persistent lesion, 3/50 (6%) with CIN2, 3/50 (6%) with CIN1 and 19/50 (38%) with complete remission. Postpartally, a conization was performed on 32/69 (46.4%) patients with prepartal CIN3 diagnosis. Histology confirmed CIN3 in 27/32 (84.4%) cases and CIN2 in 4/32 (12.5%). In 1/32 (3.1%) patient diagnosed with persistent CIN3 8 weeks after caesarean the cone revealed a microinvasive carcinoma (age 37, HPV-type 16+).
High-grade CIN lesions diagnosed during pregnancy have a high likelihood to regress postpartally, whereas progression to a carcinoma is rare. Close and continuous monitoring, increasingly strenuous with progressing pregnancy, rarely results in therapeutic consequences. The aim should be to improve patient compliance for postpartal FU.