Colposcopic assessment and management of the HPV infection in pregnancy

C. Berceanu, E. Brătilă, M.M. Cîrstoiu, S. Berceanu, C. Mehedințu, R. Ciortea, I.A. Gheonea, R. Bohîlțea, M. Mitran, S. Vlădăreanu

Rezumat: The aim of colposcopic examination during pregnancy is, on one hand, to exclude invasive cancer, and secondly to provide additional support for conservative management of intraepithelial lesions. The transformation zone is usually fully examined in this situation because the endocervical columnar epithelium becomes externalized after the 20th gestational week. Colposcopy is recommended for all pregnant women, including adolescents with HSIL. Biopsy of suspicious CIN 2, 3 or neoplastic lesions is preferred. Colposcopy is also recommended in HPV-positive pregnant women with ASC-US or LSIL. Cervical cancer diagnosis during pregnancy represents a threat not only to the patient but in certain cases a clinical finding. Because most women with risk factors for the occurrence of CIN or cervical cancer are of childbearing age, pregnancy status is also an opportunity to achieve cervical screening. Due to physiological changes of the cervix during pregnancy, colposcopy can be a challenge for practitioners and should be performed by experienced examiners. The management of the histological diagnosis of CIN 1 for the pregnant woman is represented by reevaluation without imposition of treatment. The management of CIN 2 or 3 in pregnancy requires colposcopic evaluation and biopsy. Endocervical curettage is excluded. Diagnostic excision is not indicated in the absence of invasive cancer. Cytological and colposcopic reassessment after at least 6 weeks postpartum is mandatory.
Cuvinte cheie: transformation zone, cytology, CIN, histology, post-partum treatment.