title: Perinatal High-Grade Cervical Cytology: A Case Series From a Safety Net Institution.
abstract: OBJECTIVE
  To describe the outcomes of women with high-grade cervical cytology in pregnancy and to identify factors that predict completion of appropriate postpartum follow-up.
  
  
  METHODS
  We describe a case series of all patients with high-grade cervical cytology collected during pregnancy between 2007 and 2011 at a single institution. Patients were considered adherent with follow-up if they received any kind of postpartum evaluation or treatment for their cervical dysplasia at our institution within 9 months of delivery.
  
  
  RESULTS
  Of 138 women with high-grade cervical cytology in pregnancy, 87 (63%) had high-grade squamous intraepithelial lesion, 47 (34%) had atypical squamous cells that cannot rule out high-grade (ASC-H), and 4 (3%) had atypical glandular cells (AGC). Most patients (81%) underwent colposcopy during pregnancy. A total of 48 patients (43%) had biopsies performed, 26 (54%) were CIN 2 or 3, and one (2%) was adenocarcinoma in situ (AIS). A total of 97 (70%) of 138 patients completed recommended postpartum follow-up, resulting in the detection of one additional case of AIS and one case of invasive adenocarcinoma. Hispanic ethnicity (odds ratio [OR], 3.6; confidence interval [CI], 1.4-9.1), being married (OR, 4.5; CI, 1.6-12.4), being employed (OR, 3.7; CI, 1.3-10.5), and CIN2 or 3 on antenatal biopsy (OR, 9.8; CI, 2.0-47.9) were all significantly associated with completion of postpartum follow-up.
  
  
  CONCLUSIONS
  Colposcopy during pregnancy resulted in the detection of one case of AIS. Postpartum evaluation and treatment detected an additional case of AIS as well as one case of invasive cervical adenocarcinoma. Whereas certain demographic characteristics were associated with completion of recommended follow-up, the strongest association is with a high-grade biopsy during pregnancy.
authors.affiliation: 1School of Medicine, University of Colorado, Aurora, CO, and 2Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Mazzoni
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Bienenfeld
authors.forename: Mona B
authors.initials: MB
authors.lastname: Krull
authors.forename: Torri D
authors.initials: TD
authors.lastname: Metz
authors.forename: Meredith J
authors.initials: MJ
authors.lastname: Alston
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D055118:Medication Adherence; D018743:Perinatal Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000473:pathology*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D055815:Young Adult