From the Guidelines
A patient should typically get a Pap smear at their first prenatal appointment if they are due for cervical cancer screening, as the current recommendation is to perform a Pap test if the patient hasn't had one within the past three years for conventional cytology or five years for co-testing (Pap plus HPV testing) 1.
Importance of Screening
The screening is important during pregnancy because it can detect cervical abnormalities early, allowing for appropriate monitoring or intervention.
- The first prenatal visit provides an excellent opportunity to ensure this important screening is completed, as some women may not regularly access preventive healthcare outside of pregnancy.
- The procedure is safe during pregnancy and involves collecting cells from the cervix using a small brush or spatula.
- If abnormal results are found, follow-up may include colposcopy, which can also be safely performed during pregnancy. However, more invasive procedures like cervical biopsies are typically delayed until after delivery unless there is concern for invasive cancer, as stated by the American Cancer Society guidelines 1.
Screening Guidelines
According to the USPSTF recommendations, screening for cervical cancer should begin at age 21 years, with women aged 21 to 29 years receiving cytology screening every 3 years, and women aged 30 to 65 years being screened every 5 years with the combination of HPV testing and cytology (“cotesting”) 1.
- Women should discontinue screening after age 65 years if they have had 3 consecutive negative cytology tests or 2 consecutive negative cotest results within the 10-year period prior to ceasing screening, with the most recent test occurring within the last 5 years.
- Completing this screening early in pregnancy allows time for any necessary follow-up while avoiding procedures in late pregnancy, which is in line with the guidelines from the American Cancer Society 1.
From the Research
Pap Smear Screening During Pregnancy
- The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women should have a Pap smear screening if they are due for one, but it is not a routine test during pregnancy 2.
- A study published in the Journal of General Internal Medicine found that most women in the United States report having had at least one Pap smear in their lifetime, and 55% of women with no history of abnormal smears undergo Pap smear screening annually 3.
- However, another study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology found that the prevalence of abnormal Pap smears among pregnant women is low, but opportunistic cervical screening during pregnancy can be beneficial 4.
Benefits of Pap Smear Screening During Pregnancy
- A study published in Ginekologia Polska found that routine antenatal Pap smear is an important examination, and 96.9% of respondents had undergone Pap smear, with 80.6% having it performed during pregnancy 5.
- Another study published in the Asian Pacific Journal of Cancer Prevention found that Pap smear screening during pregnancy can help identify precancerous lesions, and factors associated with abnormal Pap smears in pregnant women include low BMI, multiple partners, and being a government officer 6.
Guidelines for Pap Smear Screening During Pregnancy
- The 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests recommend that pregnant adolescents with minor Pap abnormalities may be followed rather than referred for immediate colposcopy 2.
- Postponing colposcopy in pregnant, reproductive-age women with minor Pap changes until after delivery is now acceptable, according to the guidelines 2.
- Midwives can play a crucial role in providing safe and expert cancer screening care to women during pregnancy, using clinical judgment and staying up-to-date with the latest guidelines and research 2.