I have a patient, 23 years old, primigravida, pregnant 7 weeks with single, viable intrauterine pregnancy.Diagnosed 1 month before pregnancy as having a low-grade squamous intraepithelial lesion.That time was presented with postcoital bleeding since the beginning of her marriage(& months).Next Pap smear is due after 5 months, but she presented now with postcoital bleeding.What do You advise?
Good morning
How does her cervix look on examination? I would apply acetic acid and get a better idea before proceeding with any biopsies. It is safe to perform biopsies in pregnancy.
Rabbie
No obvious abnormality.We follow the protocol, to do another Pap after 6 months and then if abnormal to proceed to colposcopy and biopsy.Shell I proceed early? Any proof it will be beneficial?Psychologically will be very distressing independent on results for young and primigravida.Shell I send for councelling? Thank You.
You are most welcome.
I see no harm in repeating the pap in 5 months as long as there were no obvious abnormalities per your protocol. Keep me updated.
Rabbie
A Pap smear of LGSIL in pregnancy is best managed with a repeat Pap smear postpartum (anywhere from 6 week to 6 months postpartum). If you wish to be thorough, a HPV screen for high grade papilloma virus can help delineate management (earlier versus later Pap smear).
I would not perform colposcopically directed biopsy of the cervix in pregnancy unless the
a) the Pap smear was HGSIL; or
b) the HPV screen demonstrated high risk virus; and
c) colposcopy was suspicious of a CIN 3 or greater.
You should confirm this is her first abnormal Pap smear. If she has had a couple of abnormal Pap smears (LGSIL) before over a period longer than 2 years, she should probably have colposcopy as it suggests persistent disease.
The presence of abnormal bleeding may also suggest altered management. If there is associated recurrent postcoital bleeding in pregnancy this may suggest a need for colposcopy.
Interpretation of pap smear during pregnancy is extremely difficult.
I have a patient presented with post coital bleeding at 23 weeks gestation. repeated follow up with pap smear and colonoscopy were normal . One month postpartum examination revealed ugly cx biopsy , histology was squamous cell cell carcinoma.
This patient needs meticulous follow-up.
thank you very much! The next Pap smear is due after 5 months. iIam hesitant to proceed to another pap smear and biopsy now.Is there any evidence to do so?
Any evidence that it will be beneficial rather that test after 6 months?Thank You!
LGSIL is no emergency and usually doesn't cause post-coital bleeding. May be just HPV infection or STD. Rule out GC, Chlamydia, Trich. Next Pap doesn't need to be until after pregnancy. It will likely clear up on its own.
I would do colposcopy, pap test & possible biopsy at 18-20 weeks. If no evidences of invasion, i repeat examination 8weeks post partum. If invasion is suspected i refer her to Gyn. Onc team for cone biopsy & prophylactic circulage. P.S. Small colposcopic directed biopsies during pregnancy are not contraindicated in exeprt hands.
Perform microbiological investigation. After therapy (if is present any infection), repeat PAP smear with colposcopy.
If the results are again L-SIL, repeat every two months.
The best mode of delivery is vaginal
Urgent colposcopy & directed biopsy then will respond according to the result
Colposcopy, direct biopsy,p16, if no cancer,follow up in pregnancy in three month
Colposcopy and biopsy.
Is it possible to have an HPV-HR test? If it's negative, then no risk and just follow-up the patient.
Cervista HPV-HR came back non-oncogenic type of HPV and bleeding is not from the uterus.We have done speculum exam and observed cervical bleeding.So far,she is doing fine.No bleeding anymore.One of my colleagues advised HPV vaccine.Is anyone used it in pregnancy?Thank You.
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