title: Clinical management and follow-up of squamous intraepithelial cervical lesions during pregnancy and postpartum.
abstract: BACKGROUND
  The incidence of cervical cancer in pregnancy is estimated to be 1-10/10000 pregnancies. Approximately 3% of cervical cancers are diagnosed during pregnancy. The incidence of abnormal Pap smears has been reported to be 5%-8%. Data on the spontaneous evolution of an intraepithelial neoplasia during pregnancy are quite diverse. Of dysplasia cases diagnosed during pregnancy, 10%-70% regress and sometimes even disappear postpartum, while persistence in the severity of cervical neoplasia is reported in 25%-47% and progression occurs in 3%-30%. However, adequate follow-up and definitive management in the postpartum period is important. The objective of the study was to assess proper management of squamous intraepithelial lesion (SIL) during and after pregnancy, to assess regression, persistence and risk of progression and the predictive role of HPV tests.
  
  
  METHODS
  Thirty-one out of 721 pregnant women with a diagnosis of low- and high-grade SIL were observed. All patients were triaged using standard colposcopy. The histological diagnosis was assessed by colposcopic direct biopsies. In patients affected by high-SIL with colposcopic findings of suspected micro-invasive lesions, a loop electrosurgical excisional procedure (LEEP) was carried out in pregnancy. High risk HPV tests were performed using PCR. The patients were followed up with cytology and colposcopy every 6-8 weeks during gestation and nine weeks postpartum. They were re-evaluated using cytology, colposcopy and histology for a final diagnosis and, when necessary, submitted to treatment. The patients were followed up for a minimum of 5 years. The HPV test was performed once at 6-8 weeks during gestation and annually during the follow-up.
  
  
  RESULTS
  Of the 31 patients with abnormal cytology, histological analysis revealed 10 cervical intraepithelial neoplasia (CIN) 1, 5 CIN 2 and 16 CIN 3. The HPV test at diagnosis was positive for HPV 16 type in 22 cases and negative in 9. Five patients with CIN 2 and 11 with CIN 3 were followed up; 5 patients with CIN 3 with colposcopic findings of suspected microinvasive lesions were submitted to an excisional procedure with LEEP before the 16th week of pregnancy.
  
  
  CONCLUSIONS
  Performing high-risk HPV tests may improve the follow-up of patients with SIL in pregnancy and postpartum in addition to cytology and colposcopy to indicate persistence/progression of the lesions. Proper management and adequate follow-up could be proposed in pregnancy and postpartum.
authors: Department of Gynecology, Perinatology and Childhealth, University "La Sapienza" Rome, Italy. a.frega@tin.it
authors: Antonio
authors: A
authors: Frega
authors: Paolo
authors: P
authors: Scirpa
authors: Roberto
authors: R
authors: Corosu
authors: Monica
authors: M
authors: Verrico
authors: Maria Lisa
authors: ML
authors: Scarciglia
authors: Maria Rita
authors: MR
authors: Primieri
authors: Antonella
authors: A
authors: Palazzo
authors: Roberto
authors: R
authors: Iacovelli
authors: Massimo
authors: M
authors: Moscarini
mesh_terms: D000328:Adult; D004598:Electrosurgery / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*