The role of colposcopy in the management of cervical intraepithelial neoplasia during pregnancy and postpartum.
We made a colposcopic study of 149 pregnant patients with suspicious or positive Papanicolaou smears. Characteristic changes in the colposcopic images were noted to be physiologic eversion of the squamocolumnar junction, glandular hypertrophy and decidual reaction. Fourteen percent of the patients with suspicious Papanicolaou smears were normal by colposcopic examination. Sixteen percent of colposcopic interpretations of the pregnant cervix suggested CIN when in fact none was present on tissue specimens obtained by directed biopsies. There was a good correlation between colposcopic clinical diagnosis and directed tissue biopsies (79%). Furthermore, there was a strong correlation between colposcopically directed tissue biopsies and subsequent cone and hysterectomy specimens (29 cases). All cases with suspicious cytology and CIN based on colposcopic findings (130 patients with satisfactory colposcopic examinations) were managed conservatively. No invasive neoplasia was subsequently detected in this group. Morbidity for colposcopically directed biopsies in pregnancy was negligible. No massive hemorrhage, premature labor, abortion or infection occurred. Treatment for CIN was accomplished following the puerperium by cryocauterization (101 cases), conization (8 cases) or hysterectomy (21 cases). Colposcopy cannot be a substitute for histologic diagnosis. However, it supplies enough data to avoid unnecessary cone biopsies. Only 19 diagnostic cone biopsies were performed during pregnancy with the indication of positive cytology and unsatisfactory colposcopy.
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D003127:Colposcopy; D003452:Cryosurgery; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D065006:Papanicolaou Test; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011644:Puerperal Disorders / Q000601:surgery; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D014626:Vaginal Smears