The role of the mode of delivery in the alteration of intrapartum pathological cervical cytologic findings during the postpartum period

Objective: The aim of the study was to determine whether abnormal antepartum cervical cytologic findings change in the postpartum period and the relation of this alteration to the mode of delivery.

Study design: Between 1991 and 2000, 192 pregnant women with antepartum abnormal cervical cytology were identified; complete demographic, clinical and cytologic reports were available for 90 of them. Papanicolaou smear tests were collected and separated in three groups using the Bethesda classification system (ASCUS, L-SIL and H-SIL).

Results: Of the 90 women, 52 (61.1%) were delivered vaginally and 38 (38.9%) by cesarean section. No difference was found between women delivered vaginally and those delivered by cesarean section, regardin age, parity and smoking history. The overall postpartum regression rate for the 20 women with antepartum H-SIL cells was 45%. Of the 12 women with H-SIL cells who were delivered vaginally, eight (66.6%) showed regression in the postpartum period while this regression was achieved only in one (12.5%) woman, who was delivered by cesarean section (p < 0.002).

Conclusion: Postpartum spontaneous regression of suspicious Papanicolaou smears consistent with H-SIL occurs with increased frequency among women who are delivered vaginally compared to those delivered by cesarean section.

Cervical intraepithelial neoplasia; Pap test; Mode of delivery; Pregnancy

[1] Pfenninger J. L.: "Colposcopy in a family practice residency; the first 200 cases". J. Fam. Pract., 1992, 34. 67.

[2] Penna C., F allani M. G., Maggiorelli M., Zipoli E., Cardelli A., Marchionni M.: "High-grade cervical intraepithelial neoplasia (CIN) in pregnancy: clinicotherapeutic management". Tumori, 1998, 84 (5), 567.

[3] Kohan S.. Beckman E. M.. Bigelow B., Klein S. A., Douglas G W.: "T he role of colposcopy in the management of cervical intraepithelial neoplasia during pregnancy and postpartum". J. Rep rod Med., 1980, 25, 279.

[4] Benedet J. L., Selke P. A., Nickerson K. G.: "Colposcopic evaluation of abnormal Papanicolaou smears in pregnancy". Am. J Obstet. Gynecol., 1987, 157, 932.

[5] Ahdoot D., Van Nostrand K. M., Nguyen N. J., Tewari D.S., Kurasaki T., Di Saia P. J., Rose G. S.: "T he effect of route of delivery on regression of abnormal cervical cytologic findings in the postpartum period".Am. J. Ohstet. Gynecol., 1998, 178 (6丿，1116.

[6] Yost N. P., Santoso J. T., McIntire S.S.. Lliya F. A.: "Postpartum regression rates of antepartum cervical intraepithelial neoplasia II and III lesions". Ohstet. Gynecol., 1999, 93(3), 359.

[7] Michael C. W., Esfahani F. M.: "Pregnancy-related changes: a retrospective review of 278 cervical smears". Diagn. Cytopatol., 1997, 17 (2), 99.

[8] Melnikow J., Nuovo J., Willan A. R., Chan B. K., Howell L. P.: "Natural history of cervical squamous intraepithelial lesions: a meta-analysis". Obstet. Gynecol., 1998, 92, 727.

[9] Kigushi K., Bibbo M., Hasegawa T., Kurihara S., Tsutsui F., Wied GIN.: "Dysplasia during pregnancy: a cytologic follow-up study" J. Reprod. Med., 1981, 26, 66.

[10] Yoonessi M., Wieckowska W., Mariniello D., Antkowiak J.: "Cervical intra-epithelial neoplasia during pregnancy". Int. J. Gynecol Ohstet., 1982, 20, 111.

[11] Kaplan A. L., Kaufman R. H.: "Diagnosis and management of dysplasia and carcinoma in situ of the cervix in pregnancy". Clin. Ohstet. Gynecol., 1967, 10, 871.

[12] Palle C., Bangsboll S., Andreasson B.: "Cervical intraepithelial neoplasia in pregnancy". Acta Ohstet. et Gynecol. Scand., 2000, 79 (4), 306.

[13] Giraud J. R., Poulain P., Renaud-Giono A., Burtin F., Burtin J. F., Proudhon J. F., Leveque J.: "CIN and pregnancy. A propos of 16 cases and review of the literature". Gynecol. Obstet. Bio. Reprod. (Paris), 1997, 26 (5), 496.

[14] Jain A. G., Higgins R. V., Boyle M. J.: "Management of low-grade squamous intraepithelial lesions during pregnancy". Am. J. Obstet Gynecol., 1997, 177, 298.

[15] Hall J.E., Walton L.: "Dysplasia of the cervix: a prospective study of 206 cases". Am. J. Obstet. Gynecol., 1968, 100, 662.

[16J Guerra B., De Simone P., Gabrielli S., Fico P., Montanari G .. Bovicelli L.: "Combined cytology and colposcopy to screen for cervical cancer in pregnancy". J. Reprod. Med., 1998, 43 (8), 647.

[17] Madej J. G., Jr.: "Colposcopy monitoring in pregnancy complicated by CIN and early cervical cancer". Eur. J. Gynaecol. Oncol., 1996, 17 (1), 59.

[18] Baldauf J. J., Dreyfus M., Gao J., Ritter J., Philippe E.: "Management of pregnant women with abnormal cervical smears. A series of 146 patients". J. Gynecol. Obstet. Biol. Reprod. (Paris), 1996, 25 (6), 582.

[19] Coppola A., Sorosky J., Casper R., Anderson B., Buller R. E.: 'The clinical course of cervical carcinoma in situ diagnosed during pregnancy". Gynecol. Oneal., 1997, 67 (2), 162.

[20] Woodrow N., P ermezel M., Butterfield L., Rome R., Tan J., Qmnn M.: "Abnormal cervical cytology in pregnancy: experience of 811 cases". Aust.N. Z. J. Obstet. Gynaecol., 1998, 38 (2), 161.

[21] Fukuda K., Hachisuga T., Nakamura S、Matsuo N., Twasaka T., Sugimori H.: "Local immune respon沁in persisten cervical dysplasia". Obstet. Gynecol., 1993, 82, 941.