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Chapter 3 - Cervical Abnormalities in Pregnancy

Published online by Cambridge University Press:  14 July 2023

By
Parveen Abedin  and
Lina Antoun
Edited by
Swati Jha  and
Priya Madhuvrata
Swati Jha
Affiliation:
Sheffield Teaching Hospital NHS Foundation Trust
Priya Madhuvrata
Affiliation:
Sheffield Teaching Hospital NHS Foundation Trust
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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.

Keywords

pregnancyLLETZlarge loop excision of the transformation zonepreterm labourhigh gradelow gradeneoadjuvant chemotherapy (NACT)
Type
Chapter
Information
Gynaecology for the Obstetrician , pp. 23 - 30
Publisher: Cambridge University Press
Print publication year: 2023

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