Course of high-grade cervical intraepithelial neoplasia diagnosed during pregnancy

Purpose:

Management of high grade cervical intraepithelial neoplasia diagnosed during pregnancy is controversial. Currently close monitoring including colposcopy and cytology every 8 weeks is recommended.

Methods:

All pregnant women who presented with abnormal cytology at the University Medical Center Hamburg-Eppendorf from 2011 – 2017 were analyzed retrospectively.

Results:

A total of 139 pregnant women at a median age of 31 years (range 19 – 49) and abnormal cytological findings (≥Pap II) were identified. At least one prepartal biopsy was performed on 98 (70.5%) patients. 7 (7.1%) were diagnosed with CIN1, 14 (14.3%) with CIN2 and 69 (70.4%) with CIN3, whereas in 8 (8.2%) cases no dysplasia was detected. 90/139 (64.7%) were seen for postpartum follow-up (FU). Despite explicit invitation only 50/69 (72.5%) women with prepartally diagnosed CIN3 attended a postpartal FU with histology (range birth to 1^st FU: 40 – 183 days, median 62). 25/50 (50%) presented with a persistent lesion, 3/50 (6%) with CIN2, 3/50 (6%) with CIN1 and 19/50 (38%) with complete remission. Postpartally, a conization was performed on 32/69 (46.4%) patients with prepartal CIN3 diagnosis. Histology confirmed CIN3 in 27/32 (84.4%) cases and CIN2 in 4/32 (12.5%). In 1/32 (3.1%) patient diagnosed with persistent CIN3 8 weeks after caesarean the cone revealed a microinvasive carcinoma (age 37, HPV-type 16+).

Conclusions:

High-grade CIN lesions diagnosed during pregnancy have a high likelihood to regress postpartally, whereas progression to a carcinoma is rare. Close and continuous monitoring, increasingly strenuous with progressing pregnancy, rarely results in therapeutic consequences. The aim should be to improve patient compliance for postpartal FU.