Had time to read the latest journals? Catch up on some recent research by reading these mini-reviews by Dr Brett Daniels.
It is estimated that the prevalence of cervical intraepithelial neoplasia (CIN) in pregnancy is about one per cent. Once invasive cancer has been excluded, the current practice with CIN in pregnancy is careful observation with smears, colposcopy and, if necessary, colposcopically guided biopsy. This retrospective study analysed all women presenting to an Austrian colposcopy clinic between 2005 and 2010. Within the study period, the authors identified 51 pregnant women with histologically proven CIN. At the first biopsy in pregnancy, they found CIN I in 33 per cent, CIN II in 14 per cent and CIN III in 53 per cent of the women included in the study. The mean gestational age at diagnosis was 15 weeks. During the same period, they identified a control group of 51 consecutive non-pregnant women, which was matched by CIN grade at diagnosis and compared the progress of CIN in both groups. In pregnant women, examinations including Pap smear and colposcopy with or without biopsy were performed in each pregnancy trimester and eight weeks postpartum. Non-pregnant women with CIN were seen every 3–6 months and examined with colposcopy and biopsy. The postpartum evaluation of the pregnant group revealed a significantly higher tendency to spontaneous regression of CIN (57 vs 31 per cent, p=0.010) and a higher complete remission rate (41 vs 28 per cent, p=0.144) when compared to the non-pregnant group. There was also a significantly lower rate of persistence of CIN in the pregnant compared to the non-pregnant group (39 per cent vs 59 per cent), and a lower rate of disease progression (four per cent vs ten per cent). The authors conclude that careful observation of CIN in pregnancy is safe and that there is a relatively high probability of disease regression, with only a small risk of progression to higher grade disease.1
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