High-grade cervical neoplasia during pregnancy: diagnosis, management and postpartum findings.

Objectives: To study the prevalence of high-grade cervical intraepithelial neoplasia (CIN 2-3) during pregnancy and compare the rates of persistence, progression and regression of CIN 2-3 by colposcopically guided biopsy during pregnancy with respect to the postpartum period. Also to assess biopsy results during pregnancy and postpartum in relation to histopathology after treatment of lesions.

Population: Pregnant women with a histological diagnosis of CIN 2-3 confirmed by colposcopically guided biopsy during pregnancy.

Methods: Between 1989 and 2008, 11 700 pregnant women had cytologic and simultaneous colposcopic examinations during pregnancy. A colposcopically guided biopsy was performed when colposcopically suspicious high-grade lesions were detected, regardless of cytological results. Women with a histopathological diagnosis of CIN 2-3 during pregnancy were re-evaluated by colposcopically guided biopsy and treated during the postpartum period.

Results: CIN 2-3 was diagnosed in 56 of 11 700 (0.48%) pregnant women by biopsy. Thirty women complying with the protocol were assessed postpartum by histopathological studies, of whom 70% exhibited persistence, 13.3% progression and 16.7% regression of CIN 2-3. Twenty-nine were diagnosed by conization and one by colposcopically guided biopsy during the postpartum period, which revealed invasive cervical carcinoma.

Conclusions: Due to the high rates of CIN 2-3 persistence during the postpartum period, we suggest that all patients in whom CIN 2-3 was diagnosed during pregnancy are biopsied and treated if necessary during the postpartum period, with at least a two-year follow-up control to prevent lesion recurrence.