High-grade cervical neoplasia during pregnancy: diagnosis, management and postpartum findings

Objectives. To study the prevalence of high-grade cervical intraepithelial neoplasia (CIN 23) during pregnancy and compare the rates of persistence, progression and regression of CIN 23 by colposcopically guided biopsy during pregnancy with respect to the postpartum period. Also to assess biopsy results during pregnancy and postpartum in relation to histopathology after treatment of lesions. Population. Pregnant women with a histological diagnosis of CIN 23 confirmed by colposcopically guided biopsy during pregnancy. Methods. Between 1989 and 2008, 11 700 pregnant women had cytologic and simultaneous colposcopic examinations during pregnancy. A colposcopically guided biopsy was performed when colposcopically suspicious high-grade lesions were detected, regardless of cytological results. Women with a histopathological diagnosis of CIN 23 during pregnancy were re-evaluated by colposcopically guided biopsy and treated during the postpartum period. Results. CIN 23 was diagnosed in 56 of 11 700 (0.48%) pregnant women by biopsy. Thirty women complying with the protocol were assessed postpartum by histopathological studies, of whom 70% exhibited persistence, 13.3% progression and 16.7% regression of CIN 23. Twenty-nine were diagnosed by conization and one by colposcopically guided biopsy during the postpartum period, which revealed invasive cervical carcinoma. Conclusions. Due to the high rates of CIN 23 persistence during the postpartum period, we suggest that all patients in whom CIN 23 was diagnosed during pregnancy are biopsied and treated if necessary during the postpartum period, with at least a two-year follow-up control to prevent lesion recurrence.