title: Management of cervical intraepithelial neoplasia during pregnancy: a simplified and cost-effective approach.
abstract: OBJECTIVE
  To determine the cost-effectiveness of managing an abnormal Papanicolaou (PAP) smear during pregnancy with a single colposcopic exam and biopsies, followed by Pap smears in each subsequent trimester of pregnancy and 8 weeks postpartum.
  
  
  METHODS
  We reviewed 84 pregnant women with cervical intraepithelial neoplasia (CIN) between 1983 and 1991, testing the accuracy of an initial biopsy and subsequent Pap smears, to follow the progression (or regression) of disease as determined by postpartum biopsy or Pap smears.
  
  
  RESULTS
  In 26 women with CIN1, 2 (8%) progressed to CIN3. In 29 women with CIN2, 5 (17%) progressed to CIN3. Of 29 patients with CIN3, 20 (69%) remained at CIN3 and 2 (6%) progressed to microinvasive carcinoma postpartum, confirmed by conization. No invasive carcinoma was missed. The cost of colposcopy with biopsies and Pap smear is $304, whereas cost of a Pap smear only is $30.
  
  
  CONCLUSIONS
  Single colposcopy with biopsies at the beginning of pregnancy and Pap smears during subsequent trimesters and postpartum should be adequate follow-up to prevent progression to invasive cancer and represents a significant cost savings.
authors.affiliation: *Departments of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX †Departments of Pathology, University of Texas Medical Branch at Galveston, Galveston, TX.
authors.forename: C H
authors.initials: CH
authors.lastname: Roberts
authors.forename: T V
authors.initials: TV
authors.lastname: Dinh
authors.forename: E V
authors.initials: EV
authors.lastname: Hannigan
authors.forename: R B
authors.initials: RB
authors.lastname: Yandell
authors.forename: V J
authors.initials: VJ
authors.lastname: Schnadig