Skip to main content Accessibility help
×
Hostname: page-component-77c89778f8-vsgnj Total loading time: 0 Render date: 2024-07-25T01:50:45.158Z Has data issue: false hasContentIssue false

Chapter 3 - Cervical Abnormalities in Pregnancy

Published online by Cambridge University Press:  14 July 2023

Swati Jha
Affiliation:
Sheffield Teaching Hospital NHS Foundation Trust
Priya Madhuvrata
Affiliation:
Sheffield Teaching Hospital NHS Foundation Trust
Get access

Summary

Conservative management of high-grade pre-invasive disease of the cervix (CIN2–3 ) during pregnancy is acceptable. However, persistent high-risk HPV infection is a major risk factor for CIN2+ persistence. Close follow-up with HPV testing, and antenatal and post-partum colposcopic evaluation including directed biopsies are necessary. However, women who have undergone excisional treatment for CIN2 and above have an increased risk of preterm delivery and preterm rupture of membranes (PROM). Smoking is an important impact factor that could change the vaginal environment influencing the viral load. Treated patients should be informed about increased risk of preterm births and clinicians should offer the most appropriate treatment to optimise the chances of a healthy pregnancy without compromising women’s treatment options. In women diagnosed with invasive cervical cancer in pregnancy, the option of neoadjuvant chemotherapy (NACT) as a means of reaching fetal maturity versus termination followed by definitive management should be offered to the patient.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kyrgiou, M., Koliopoulos, G., Martin-Hirsch, P., et al. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: Systematic review and meta-analysis RID B-6887-2009. Lancet, 367 (2006), 489–98.CrossRefGoogle ScholarPubMed
Quinn, M., Babb, P., Jones, J., et al. Effect of screening on incidence of and mortality from cancer of cervix in England: Evaluation based on routinely collected statistics. BMJ, 318 (1999), 904–8.Google Scholar
Moscicki, A., Schiffman, M., Kjaer, S. and Villa, L. L.. Updating the natural history of HPV and anogenital cancer. Vaccine, 24 (2006), 4251.CrossRefGoogle ScholarPubMed
Wright, T. C. Jr, Massad, L. S. and Dunton, C. J., et al. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. Obstetrics & Gynecology, 197 (2007), 340–5.Google ScholarPubMed
Chen, C., Xu, Y., Huang, W., Du, Y. and Hu, C.. Natural history of histologically confirmed high-grade cervical intraepithelial neoplasia during pregnancy: Meta-analysis. BMJ Open, 11 (2021), e048055.CrossRefGoogle ScholarPubMed
Lancucki, L., ed. Cervical Screening Programme, England: 2005–06. (NHS Information Centre, 2006). https://bmjopen.bmj.com/content/11/8/e048055Google Scholar
Prendiville, W., Cullimore, J. and Norman, S.. Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia. British Journal of Obstetrics and Gynaecology, 96 (1989), 1054–60.Google ScholarPubMed
Wright, T. C. Jr, Cox, J. T., Massad, L. S., et al. 2001 consensus guidelines for the management of women with cervical intraepithelial neoplasia. American Journal of Obstetrics and Gynecology, 189 (2003), 295304.CrossRefGoogle ScholarPubMed
Herbert, A. and Smith, J. A.. Cervical intraepithelial neoplasia grade III (CIN III) and invasive cervical carcinoma: The yawning gap revisited and the treatment of risk. Cytopathology, 10 (1999), 161–70.CrossRefGoogle ScholarPubMed
Andía, D., Mozo de Rosales, F., Villasante, A., et al. Pregnancy outcome in patients treated with cervical conization for cervical intraepithelial neoplasia. International Journal of Gynecology & Obstetrics, 112 (2011), 225–8.Google Scholar
Arbyn, M., Kyrgiou, M., Simoens, C., et al. Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: Meta-analysis RID B-6887–2009. BMJ, 337 (2008), a1284.CrossRefGoogle Scholar
Gkrozou, F., Antoun, L., Risk, R., et al. The risk of preterm delivery following large loop excision of the cervix: An observational cohort study. Clinics in Surgery, 5 (2021), 16.Google Scholar
Jakobsson, M., Gissler, M., Tiitinen, A., et al. Treatment for cervical intraepithelial neoplasia and subsequent IVF deliveries. Human Reproduction, 23 (2008), 2252–5.Google Scholar
Hein, M., Petersen, A. C., Helmig, R. B., et al. Immunoglobulin levels and phagocytes in the cervical mucus plug at term of pregnancy. Acta Obstetrica et Gynecologia Scandinavica, 84 (2005), 734–42.Google ScholarPubMed
Werner, C. L., Lo, J. Y., Heffernan, T., et al. Loop electrosurgical excision procedure and risk of preterm birth. Obstetrics & Gynecology, 115 (2010), 605–8.Google Scholar
Himes, K. P. and Simhan, H. N.. Time from cervical conization to pregnancy and preterm birth. Obstetrics & Gynecology, 109 (2007), 314319.Google Scholar
Fischer, R. L., Sveinbjornsson, G. and Hansen, C.. Cervical sonography in pregnant women with a prior cone biopsy or loop electrosurgical excision procedure. Ultrasound in Obstetrics & Gynecology, 36 (2010), 613–17.CrossRefGoogle ScholarPubMed
Simoens, C., Goffin, F., Simon, P., et al. Adverse obstetrical outcomes after treatment of precancerous cervical lesions: A Belgian multicentre study. British Journal of Obstetrics and Gynaecology, 119 (2012), 1247–55.Google Scholar
Castanon, A., Brocklehurst, P., Evans, H., et al. Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England: Retrospective-prospective cohort study. British Medical Journal, 16 (2012), e5174.Google Scholar
Turlington, W. T., Wright, B. D. and Powell, J. L.. Impact of the loop electrosurgical excision procedure on future fertility. Journal of Reproductive Medicine, 41 (1996), 815–18.Google Scholar
Kyrgiou, M., Athanasiou, A., Paraskevaidi, M., et al. Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: Systematic review and meta-analysis. British Medical Journal, 354 (2016), i3633.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence. Preterm Labour and Birth [Nice Guidelines NG25]. (2019). www.nice.org.uk/guidance/ng25Google Scholar
La Russa, M. and Jeyarajah, A. R.. Invasive cervical cancer in pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology, 33 (2016), 4457, doi:10.1016/j.bpobgyn.2015.10.002. Epub 2015 Oct 23Google Scholar
Hong, D. K., Kim, S. A., Lim, K. T., et al. Clinical outcome of high-grade cervical intraepithelial neoplasia during pregnancy: A 10-year experience. European Journal of Obstetrics & Gynecology and Reproductive Biology, 236 (2019), 173–6. Epub 2019 Mar 25. PMID: 30933887. https://doi.org/10.1016/j.ejogrb.2019.03.023CrossRefGoogle Scholar
Reed, N., Balega, J., Barwick, T., et al. British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice. European Journal of Obstetrics & Gynecology and Reproductive Biology, 256 (2021), 433–65.Google Scholar
Kaplan, K. J., Dainty, L. A., Dolinsky, B., et al. Prognosis and recurrence risk for patients with cervical squamous intraepithelial lesions diagnosed during pregnancy. Cancer, 102 (2004), 228–32.CrossRefGoogle ScholarPubMed
Ackermann, S., Gehrsitz, C., Mehlhorn, G., et al. Management and course of histologically verified cervical carcinoma in situ during pregnancy. Acta Obstetrica et Gynecologica, 85 (2006), 1134–7.CrossRefGoogle ScholarPubMed
Nguyen, C., Montz, F. J. and Bristow, R. E.. Management of stage 1 cervical cancer in pregnancy. Obstetrical & Gynecological Survey, 55 (2000), 633–43.Google Scholar
Nitish, B., Zhujun, S., Dongchen, W., et al. Diagnosis and treatment of cervical cancer in pregnant women. Cancer Medicine, 8 (2019), 5425–30.Google Scholar
Van Calsteren, K., Vergote, I. and Amant, F.. Cervical neoplasia during pregnancy: Diagnosis, management and prognosis. Best Practice & Research Clinical Obstetrics & Gynaecology, 19 (2005), 611–30.Google Scholar
Hricak, H., Powell, C. B., Yu, K. K., et al. Invasive cervical carcinoma: Role of MR imaging in pretreatment work up costs minimisation and diagnostic efficacy analysis. Radiology, 198 (1996), 403–9.Google Scholar
Moore, K. N., Herzog, T. J., Lewin, S., et al. A comparison of cisplatin/paclitaxel and carboplatin/paclitaxel in stage IVB, recurrent or persistent cervical cancer. Gynaecologic Oncology, 105 (2007), 299303.Google ScholarPubMed
Karam, A., Feldman, N., Holschneider, C., et al. Neoadjuvant cisplatin and radical Caesarean hysterectomy for cervical cancer in pregnancy. Nature Clinical Practice Oncology, 4 (2007), 375–80.CrossRefGoogle ScholarPubMed
Egan, P. C., Costanza, M. E., Dodlon, P., et al. Doxorubicin and cisplatin excretion into human milk. Cancer Treatment Reports, 69 (1985), 1387–9.Google ScholarPubMed
Alouni, S., Rida, K. and Mathevet, P.. Cervical cancer complicating pregnancy: Implications of laparoscopic lymphadenectomy. Gynecologic Oncology, 108 (2008), 472–77.Google Scholar
Riemma, G., Della Corte, L., Vitale, S. G., et al. Surgical management of endocervical and decidual polyps during pregnancy: Systematic review and meta-analysis. Archives of Gynecology and Obstetrics, (2022), Epub. https://doi/org/10.1007/s00404-022-06550-zGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×