Retrospective observational study:the natural history of cervical intraepithelial neoplasia during pregnancy

Abstract

Aims: To assess the persistence, regression and progression of cervical dysplasia in pregnancy, within a tertiary London hospital.|
Methods: All cases referred for colposcopy at Kings College Hospital during pregnancy, between September 2011 and August 2017, were retrospectively identified. Women underwent a tissue biopsy only if clinically indicated. All women were seen for colposcopy between 3 and 6 months postnatally. Women were excluded from the final analysis if they were referred for reasons other than an abnormal smear, and if follow-up data were not available.|
Results: 82 pregnant patients (median age: 35 years, range: 27-48 years) were seen during this period. 56 cases were referred for colposcopy due to abnormal smears and had complete follow-up data; the other cases were excluded. 24 had high-grade cervical intraepithelial neoplasia (CIN). Of these, CIN regressed in 6/24 (25%) cases and persisted, necessitating excisional treatment, in 18/24 cases (75%). No cervical cancer cases were diagnosed. The regression, persistence and progression rates of the remaining 32 cases with low-grade smear abnormalities during pregnancy were: 20/32 (63%), 6/32 (19%) and 6/32 (19%) respectively.|
Conclusion: This study shows high rates of regression of low-grade abnormalities following pregnancy. Additionally, there were no cases of progression of high-grade CIN to cancer, thus supporting safe conservative management of these women. Post-partum follow-up remains essential for those with high-grade CIN due to significant levels of persistence.