A B C D E F G H I J K L M N O P Q R S T U V W X Y Z All
Panicker, Seetha
- Screening for Cervical Cancer in Pregnancy-our Experience
Authors
1 Department of Obstetrics and Gynaecology, PSG Institute of Medical Sciences & Research, Coimbatore, IN
2 Department of Obstetrics and Gynaecology, PSG Institute of Medical Sciences & Research, Coimbatore, IN
Source
Indian Journal of Public Health Research & Development, Vol 4, No 3 (2013), Pagination: 202-206Abstract
Objective:
• To diagnose Cervical intraepithelial neoplasia in pregnancy with Visual Inspection of cervix with Acetic acid and Lugol`s Iodine and Papsmear as screening tool.
• To assess the difficulties of screening and colposcopy in pregnancy.
Design: Retrospective study
Materials and Method: 350 antenatal women less than 20 weeks of gestational age attending the OG OPD at PSG Hospitals, Coimbatore were subjected to visual inspection of cervix with Acetic acid and Lugol's iodine and Pap smear. A Pap smear was taken from all pregnant women following which visual inspection of cervix with Acetic acid and Lugol's iodine were done by applying 5% Acetic acid followed by Lugol's iodine. If there was an abnormality on visual inspection of cervix with Acetic acid and Lugol's iodine or cytology patients were recalled for colposcopy.
Results: 350 pregnant women both primigravidae and multigravidae were screened (n=350). Among them the screen positives for visual inspection of cervix with Acetic acid and Lugol's Iodine=30 (8.57%). Three patients had abnormal results on Pap smear (0.8%), (2 had HSIL, 1 had LSIL). Of the 30 patients who were recalled for colposcopy, 4 (13.3%) were abnormal (CIN I=2, CIN II&CIN III=2).
Conclusion: Though visual inspection of cervix with Acetic acid and Lugol's iodine has high false positivity rate because of physiological changes in pregnancy, it is still a feasible screening method in a low resource setting like ours. In our study, we had 4 positives and all of them were picked up by visual inspection of cervix with Acetic acid and Lugol's iodine. So screening for cervical cancer during pregnancy is worthwhile as antenatal clinic may be the only opportunity.
Keywords
Pregnancy, Visual Inspection of Cervix with Acetic Acid and Lugol's Iodine, PAP Smear, Colposcopy
References
- Copeland LJ, Landon MB. Malignant diseases and pregnancy. Jn; Gabbe SG, Neibyl JR, Simpson JL, editors obstetrics; normal and problem pregnancies Newyork curchill Livingstone 1996 P 1155-81
- Vural E, Gonenc L, Aka N, et al (2004). Antenatal kontrollerde pap smear taramasi ve sonuclari. Turkiye Aile Hekimligi Dergisi, 8, 111-5.
- Canfell K, Sitas F, Beral V (2006). Cervical cancer in Australia and United Kingdom: comparison of screening policy and uptake, and cancer incidence and mortality. Med J Aust, 185, 482-6.
- Gilstrap LC, Oh W (eds). Guidelines for Perinatal Care, ed 5. Washington DC: American academy of paediatrics and the American collage of Obstetricians and Gynecologists, 2002.
- Ma L - Zhonghua Fu Chan Ke Zhi; pregnancy related cervical cytological changes and clinical management – 01 – FEB-2011; 46(2): 84-87
- Donders GG, Van streaten D, Hooft P, De Wet GH; Detection of candida cells from pap smear during pregnancy. Eor J obstet Gynecol Reprod Biol 1992 jan 9; 43(1) : 13-8
- Wetta LA – J Low Genit Tract Dis – 01 – JUL – 2009; 13(3): 182-5. The management of cervical intraepithelial neoplasia during pregnancy: is colposcopy necessary?
- Nguyen c,Montz FJ, Bristow RE. Management of stage 1 cevical cancer in pregnancy. Obstet gynecol surv 2000; 55 ; 633-643
- Wright T C Ir, Cox JT, Massad LS, et al. consensus guidelines for the management of women with cervical cytological abnormalities. JAM Med Assoc 2002 ; 287 ; 2120-2129
- Solomon D, Davey D, Kurman R et al; forum group member; Bethesda 2001 workshop. The 2001 bethesda system; terminology for reporting results for cervical cytology. JAM Med assoc 2002; 287; 2114-2119
- Zemlickis D, Lishner M, Dogendorfer P et al. maternal and fetal outcome after invasive cervical cancer in pregnancy. J Clin oncol 1991; 9:1; 1956-1961.
- Campion MJ, Sedlacok TV, colposcopy in pregnancy. Obstet Gynecal Clin NorthAm 1993;20;153-163.
- Economos K, Perez-Veridiano N, Delke I et al. abnormal cervical cytology in pregnancy; a 17 year experience Obstet Gynecol 1993; 81 ; 915-918
- Palle c bangsbell S andreasson B. cervical intraepithelial neoplasia in pregnancy , Acta obstet Gynecol scand 2000;79;306-310
- Kaminski PF, Lyon DS, Sorosky JI et al. significance of a typical cervical cytology in pregnancy. AM J perinatal 1992 ; 9 ; 340-343
- Vlahos G, Rodolakis A, Diakomanolis. Eet al. conservative management of cervical intraepithelial neoplasia (CIN c2-3) in pregnant women. Obstet Gynecol invest 2002;54;78-81.
- Hendrickson MR, Kempson L. Uterus and fallopian tubes. In: Sternberg SS (ed). Histology of Pathologists. New York: Raven press, 1992, p 809.
- CampinMJ, Sedlacek TV. Colposcopy in pregnancy. Obstet Gynecol Clin North Am 1993; 20:153-163.
- Ostergard DR. the effect of pregnancy on the cervical cytology. AM J Obstet Gynecol 1979; 134: 759-760.
- Micheal CW, Esfahani FM. Pregnancy-related changes, a retrospective review of 278 cervical smears. Diagn cytopathol 1997, 17:99-107.
- Morimura Y, Fujimori K, Soeda, et al. Cervical cytology during pregnancy: comparison with non-pregnant women and management of pregnant women with abnormal cytology. Fukushima J Med sci 2002;48(1):27-37.
- Micheal CW, Esfahani FS. Pregnancy-related changes: a retroscpective review of 278 cervical smears. Diagn cytopathol 1997;17:99-107.
- Pischarodi LR, Jovanoska S. Spectrum of cytologic changes in preganacy: a review of 100 abnormal cervicovaginal smears, with emphasis on diagnostic pitfalls. Acta cytol 1995;39:905-8)
- Aria-stella J. atypical endometrial changes associated with the presence of chorionic tissue. Arch Pathol 1954;58:112-128.
- Arias-Stella J.a topographic study of uterine epithelial atypia associated with chorionic tissue: demonstration of alteration in the endocervix. Cancer 1959;12:310-313.
- Schneider V, Barnes LA. Ectopic decidual reaction of uterine cervix, frequency and cytologic presentation. Acta Cytol 1981;25:616-622.
- Valente Pt; Schantz HD, Schultz M. cytologic atypia associated with microglandular hyperplasia.
- Shargo SS. The Aria-Stella reaction. A case report of cytologic presentation. 1977;21:310-313.
- Mulvany Nj, Khan A, Ostor A. Aria-Stella reaction associate with cervical pregnancy; report of a case with cytologic presentation. Acta Cytol 1994;38:218-222)
- Behnam K, Mariano E. the value of colposcopy in evaluating cervical intraepithelial neoplasia during pregnancy. Diagn Gynecol Obstet 1982;4;133-135
- Orr JW IR, Barrett JM, orr PF et al. the efficacy and safety of the cytobrush during pregnancy. Gyncol oncol 1992 ; 44; 260-262.
- Lieberman RW, Henry Mr, Laskin WB et al. colposcopy in pregnancy;directed brush cytology compared with cervical biopsy. Obstet Gynecol 1999; 94;198-203
- Economas K, Perez – Verdiano N, Delke 1 et sl. Abnormal cervical cytology in pregnancy. A 17 year experience. obstetGynecol 1993 ; 81 ; 915-918.
- Coppola A, Sorosky J, Casper R et al. the clinical course of cervical carcinoma in situ diagnosed during pregnancy. Gynecol oncol 1997 ; 67 ; 162-165
- Baldauf JJ, DREyfus M, RitterJ et al. colposcopy and directed biopsy reliability during pregnancy; a cohort study. Eur J obstet Gynecol Reprod Biol 1995; 62; 31-36.
- Wright TC, Massad LS, Dunton CJ, et al. 2006 Consensus guidelines for the management of women with abnormal cervical screening tests. J Low Genit Tract Dis 2007;11(4):201-22.