Management of cervical dysplasia in the context of pregnancy

A. Petca, C. Oprescu, D. Radu, R. Petca, A. Burnei- Russu, D. Străjean, M. Zvâncă, M. Boț

Rezumat: Introduction. Intraepithelial cervical neoplasia and cervical cancer are the most common cytological diagnoses encountered in the population of pregnant patients and are a global health problem. The most important risk factor for cancer or intraepithelial cervical neoplasia (CIN) is the persistence of infection with Human Papilloma Virus, oncogenic strains. 8-12% of pregnant patients have a modified cytological examination at the beginning of pregnancy. Under these circumstances, it becomes a delicate problem to interpret a Papanicolau exam in the population of patients at the beginning of pregnancy, as long as an algorithm of practice is not standardized. Current protocols for pregnant women with cervical dysplasia are not well defined, and are often based on data on untreated patients or on retrospective analysis in pregnant patients. Materials and method. We report the cases of six patients with abnormal cervical cytology at the routine exam at the onset of pregnancy. Electroresection with diathermal bile and prophylactic cervical cerclaj was performed in order to maintain the pregnancy with hemostatic, but also for curative purposes. Results. In 3 out of 6 patients complete healing was achieved post-large loop excision of the transformation zone and prophylactic cervical cerclaj, with sustained fertility, at 6 weeks postpartum PAP examination resulting in negative for intraepithelial or malignant lesion. In 1/6 cases the same protocol was applied, but at 16 weeks, the pregnancy interrupted its evolution and PAP cytology was with the ASC-H result at 2 weeks postabortum, requiring completion of the resection. One-sixth of the reported patients underwent diagnostic biopsy at 15 weeks of pregnancy (in situ carcinoma) with diathermal excision at 6 weeks postpartum. The sixth patient has an evolving pregnancy with a prophylactic cerclaje and electroresection with diathermal bile, with a satisfactory HP result, the edges of the resection piece free from disease. Conclusions. The abnormal cytological changes of the Papanicolau exam at the beginning of pregnancy for the 6 cases were H-SIL and ASC-H with histopathological results: medium to high grade CIN. Early identification of these lesions and the approach of individualized treatments can reduce the number of radical surgical procedures and keep pregnancies up to date with live babies without restriction of intrauterine growth.
Cuvinte cheie: cervical dysplasia, intraepithelial cervical neoplasia, pregnancy, Human Papilloma Virus, H-SIL, L-SIL, ASC-H, ki-67, p-16.