Clinical Analysis Of 57 Cases Of Cervical Intraepithelial Neoplasia Screening During Pregnancy

Objective:To observe the diagnosis,treatment and clinical outcome of pregnant women with abnormal cervical cytology,and to explore the cytological conversion and relevant influencing factors of these pregnant women.Methods: 90 pregnant women with abnormal cervical cytology were collected from Shengjing Hospital of China Medial University during March 2012 to November 2017.We followed up the clinical characteristics,methods of diagnosis and treatment as well as the outcome of Cervical Cytology after termination of pregnancy.Results: Followed up 57 cases,including 35 cases of DNA ploidy abnormalities and ASCUS,7cases of ASC-H,8 cases of LSIL and 7 cases of HSIL.While pathological biopsy was performed in 12 cases and cervical surgery was performed in 10 cases.47 cases selected conservative observation during pregnancy and required reexamination after termination of pregnancy.Among 47 pregnant women selected conservative observation,(1)32 cases found cervical cytologic abnormality in early pregnancy,15 cases found abnormal in mid to late gestation,and followed up until 12 months after termination of pregnancy.The overall regression rate of cervical cytology were 71.9% and 60.0%,respectively.There was no significant difference between the two groups(P > 0.05).(2)31 cases terminated pregnancy in early pregnancy and 6 cases in mid to late gestation.They were followed up until 12 months after termination of pregnancy and the overall regression rate of cervical cytology was 71.0% and 62.5%,respectively.There was no significant difference between the two groups(P >0.05).(3)25 cases of ectopic pregnancy and 22 cases of normal intrauterine pregnancy were followed up until 12 months after termination of pregnancy.The overall regression rate of cervical cytology was 76.0% and 59.1%,respectively.There was no significant difference between the two groups(P >0.05).Forty cases were examined by HPV in 47 pregnant women with conservative observation,included 25 cases were positive and 15 cases were negative.The overall negative conversion ratio of cervical cytology was 52.0% and 86.7% by follow up to 12 months after termination of pregnancy,respectively.However,there were 14 cases with smoking history and 33 cases without smoking history,the overall negative conversion ratio of cervical cytology was 42.9% and 78.8% in the same situation,respectively.The difference was statistically significant by comparison(P<0.05).In addition,3 cases of vaginal bleeding during pregnancy with abnormal cervical cells were followed up in the group,but they refused to confirm the diagnosis by colposcopy biopsy during pregnancy.Cervical cancer was found in our hospital after termination of pregnancy.Conclusion:(1)Pregnancy itself did not impact on the negative conversion of cervical cytology abnormalities during pregnancy but pregnant women with HPV infection or smoking habits will not benefit the regression of cytological abnormalities.(2)After the malignant lesion was excluded,pregnant women with abnormal cervical cytology during pregnancy can choose conservative observation,but they need to be closely followed up postpartum.(3)The abnormality of cervical cytology with HPV infection during pregnancy should not be ignored.We should pay attention to HPV regression and cytological review in HPV positive patients during pregnancy.(4)Take cervical cancer screening in pregnant women seriously.Colposcopy is necessary when cytological examination abnormalities or clinical symptoms and signs can not exclude cervical cancer,and all pregnant women with abnormal cervical examination should be closely followed up after termination of pregnancy.