What are the guidelines for pap (Papanicolaou) smears in pregnant women?

From the Guidelines

Pregnant women should continue with routine cervical cancer screening according to their age and previous screening history, with the understanding that colposcopy and cervical biopsies are generally limited to cases where invasive cancer is suspected due to increased bleeding risk 1.

Key Considerations for Pap Smears in Pregnancy

• The procedure for a Pap smear is safe during pregnancy and is performed in the same manner as for non-pregnant women, using a speculum examination and gentle collection of cervical cells.
• If the Pap smear results are normal, no additional testing is needed during pregnancy.
• For abnormal results, colposcopy can be safely performed during pregnancy, but definitive treatment for cervical dysplasia is typically deferred until after delivery unless invasive cancer is diagnosed.
• Pregnancy does not increase the risk of cervical cancer progression, and most cervical abnormalities can be safely monitored throughout pregnancy with follow-up evaluation postpartum.

Screening Recommendations

• Women aged 21 to 29 years should perform cytologic testing alone every 3 years.
• Women aged 30 to 65 years should perform cytologic and HPV cotesting every 5 years (preferred), or perform cytologic testing alone every 3 years (acceptable).
• Women over 65 years should discontinue screening if there has been an adequate number of negative screening results previously and if there is no history of high-grade squamous intraepithelial lesions, adenocarcinoma in situ, or cancer.

Special Considerations

• Colposcopy is preferred for pregnant women with low-grade squamous intraepithelial lesions, but evaluation may be deferred until no earlier than six weeks postpartum 1.
• Treatment during pregnancy is unacceptable unless invasive carcinoma is identified.
• Women who have not had recent screening should not delay getting a Pap smear due to pregnancy, as it provides an important opportunity for cervical cancer detection.

From the Research

Guidelines for Pap Smears in Pregnancy

The guidelines for Pap smears in pregnant women are as follows:

• Pap smears can be performed during pregnancy, and it is a good opportunity to screen for cervical cancer [(2,3,4,5,6)].
• The prevalence of abnormal Pap smears in pregnant women is low, ranging from 0.8% to 6.7% [(2,4,5)].
• Factors associated with abnormal Pap smears in pregnant women include low BMI, multiple partners, being a government officer, young coitarche, and more than 25 years of active sexual activity 4.
• Pregnancy provides a valuable opportunity to educate and screen women for cervical cancer when receiving prenatal care 3.
• Modifications in the 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests suggest that postponing colposcopy in pregnant, reproductive-age women with minor Pap changes until after delivery is now acceptable 3.

Screening Methods

• Pap smear is a good method for screening for cervical cancer in pregnant women, with higher sensitivity and specificity than visual inspection with acetic acid (VIA) 4.
• VIA can also be used as a screening method, but it has lower sensitivity and specificity than Pap smear 4.

Benefits of Pap Smears during Pregnancy

• Pap smear screening during pregnancy increases the coverage of the cervical cancer screening programme 6.
• It provides an opportunity to identify pre-invasive lesions in early phases of pregnancy 5.
• Pregnant women are more likely to have a Pap smear during follow-up compared to non-pregnant women 6.

Key Findings

• The majority of pregnant women have a Pap smear during the antepartum period 6.
• The contribution of the antepartum Pap smear to "over-screening" exists, but its effect is modest in countries where women on average become pregnant after the start of recommended age of screening 6.