From the Guidelines
A Pap smear can be safely performed at 14 weeks gestation, as it is considered safe throughout pregnancy and is often done during the first prenatal visit if the patient is due for screening. The procedure for performing a Pap smear during pregnancy is the same as for non-pregnant women, using a speculum to visualize the cervix and collecting cells with a brush or spatula 1. According to the 2010 guidelines for cancer, fertility, and pregnancy, a Pap smear at the first antenatal visit can help diagnose cervical cancer, and if necessary, a diagnostic large loop excision of the transformation zone (LLETZ) or conization can be performed, with the optimal time for conization being in the second trimester between 14 and 20 weeks of gestation 1. Key points to consider include:
- The cervix has increased vascularity during pregnancy and may bleed slightly more easily, but this is harmless and doesn't affect the pregnancy
- The sample collection is gentle and doesn't disturb the developing fetus or increase miscarriage risk
- If abnormal results are found, colposcopy can be performed during pregnancy, though biopsies are typically deferred until after delivery unless there's concern for invasive disease
- Some providers prefer to defer routine Pap screening until the postpartum period if a woman is up-to-date with screening, but there's no medical contraindication to performing it at 14 weeks gestation.
From the Research
Pap Smear at 14 Weeks Gestation
- A Pap smear can be performed at 14 weeks gestation, as there is no specific gestational age limit for the procedure 2, 3.
- Studies have shown that Pap smears can be safely performed during pregnancy, and the results can help identify abnormal cell changes in the cervix 2, 3.
- The prevalence of abnormal Pap smear results in pregnant women has been reported to be around 6.0-6.7% 2, with the most common abnormality being low-grade intraepithelial lesions (LSIL) 2, 3.
- Factors associated with abnormal Pap smear results in pregnant women include low BMI, multiple partners, and being a government officer 2, as well as young age at coitarche and more than 25 years of active sexual activity 2.
- The sensitivity and specificity of Pap smears for detecting precancerous cervical lesions during pregnancy have been reported to be higher than those of visual inspection with acetic acid (VIA) 2.
- Other studies have also highlighted the importance of cervical cancer screening during pregnancy, including the use of Pap smears and human papillomavirus (HPV) testing 4, 5, 6.