Management and course of histological verified cervical carcinoma in situ during pregnancy

Aims: To study the rate of regression and progression into invasive disease of patients with histological proven carcinoma in situ of the uterine cervix during pregnancy

Methods: Prospective observation of all pregnant women with biopsy-proven carcinoma in situ of the uterine cervix, gained by colposcopic guided biopsy from 1996–2004 and correlation with the route of delivery and cytologic and histologic postpartum findings.

Results: 83 patients with histological verified carcinoma in situ during pregnancy were treated conservative. Two patients were lost to follow up, one patient had an abortion and three are still pregnant. The study population of 77 patients were followed for a median of 140 days before delivery. Postpartum regression rate was 34.2%, two patients had a diagnosis of micro invasive cervical cancer on the postpartum cone biopsy, persistent carcinoma in situ was found postpartum in 63.1% of patients. No difference was seen for the route of delivery. Both patients with micro invasive carcinoma were delivered by primary caesarean section and are disease free after 24 and 38 months, respectively.

Conclusions: We recommend a conservative management for women with carcinoma in situ of the uterine cervix. We found no difference for the route of delivery regarding postpartum regression and recommend a postpartum evaluation after the puerperium. Colposcopic guided biopsy should rule out an invasive process during pregnancy. Cesarean section as the mode of delivery should be considered, if invasion is suspected.