COLPOSCOPIC EVALUATION OF PREGNANT PATIENTS WITH ABNORMAL CERVICAL SMEARS

The authors experience with colposcopy as an alternative to cone biopsy in the assessment of patients with abnormal cervical smears while pregnant is reported. 123 of 300 patients with abnormal cervical pathology were pregnant. Many patients had their 1st cervical smear at the time of the pregnancy. These patients were examined by standard colposcopic methods and biopsies were taken of lesions seen. Biopsy specimens were studied in serial sections. A cone biopsy was done only if microinvasive carcinoma was detected suspected or if a satisfactory colposcopy could not be done. Ages of patients varied from 14 to 41 and parity 0 to 4. There was a tendency for colposcopy to overestimate the severity of lesions because of the increased vascularity of the cervix due to pregnancy. However there was agreement between colposcopy and histological diagnosis in 92.7%. No invasive carcinoma was missed by colposcopy. Subsequently 55 of these patients had conization or hysterectomy. In no instance was the histological diagnosis more severe than had been determined from colposcopic evaluation. Normal cervical epithelium was found in 10 patients. 95 patients had severe dysplasia carcinoma in situ or microinvasive carcinoma. Cone biopsy was done in only 3 patients. Only 1 patient bled from the biopsy site. There were no other complications. While initial evaluation is essential the need for cone biopsy should be greatly reduced by colposcopy. Colposcopy by trained experts is considered to be the best method for investigating patients with abnormal cytology during pregnancy.