Management and evolution of cervical intraepithelial neoplasia during pregnancy and postpartum.
OBJECTIVE
To investigate the evolution of cervical intraepithelial neoplasia (CIN), and to evaluate the safety of cytological and colposcopical surveillance of women with CIN during pregnancy.


METHODS
Ninety-eight women with antenatal cytological and/or colposcopical impression of CIN were followed up during pregnancy with cytology and colposcopy every 2 months. A cytological and colposcopical reevaluation 2 months postpartum was done, and large loop excision of the transformation zone (LLETZ) was performed if appropriate. Punch or loop biopsies were only taken if there was suspicion of microinvasion.


RESULTS
In 14 of 39 (35.9%) and in 25 of 52 (48.1%) women with antenatal impression of CIN I and CIN II-III, respectively, there was postnatal impression of regression. Seven women with findings suspicious of microinvasion underwent small loop biopsies during pregnancy, but early stromal invasion (< 1 mm) was seen in just one case. There was one more case of microinvasion (1.5 mm) diagnosed postnatally in which the antenatal impression was of CIN III. 84.6% of the women with regression compared to 67.3% of the women with stable disease or progression had a vaginal delivery (P = 0.057).


CONCLUSIONS
There is a considerable regression rate of CIN after pregnancy possibly attributable to the loss of the dysplastic cervical epithelium during cervical ripening and vaginal delivery. Frequent cytological and colposcopical evaluation seems to be safe. Small loop biopsies are recommended in cases of possible microinvasion.
Department of Obstetrics & Gynecology and Cytology Laboratory, Ioannina University Hospital, Ioannina, Greece. gkoliopoulos@aol.com
Evangelos
E
Paraskevaidis
George
G
Koliopoulos
Sophia
S
Kalantaridou
Lambrini
L
Pappa
Iordanis
I
Navrozoglou
Kostas
K
Zikopoulos
Dimitrios E
DE
Lolis
D003127:Colposcopy; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis; D018743:Perinatal Care / Q000379:methods*; D049590:Postpartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000209:etiology / Q000473:pathology / Q000628:therapy* / Q000821:virology; D014412:Tumor Virus Infections / Q000175:diagnosis; D002583:Uterine Cervical Neoplasms / Q000209:etiology / Q000628:therapy* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000209:etiology / Q000473:pathology / Q000628:therapy*