From the Guidelines
Pregnant women should undergo cervical cancer screening according to the same guidelines as non-pregnant women, with routine screening not being altered due to pregnancy. The American College of Obstetricians and Gynecologists (ACOG) guidelines for cervical cancer screening in pregnancy are based on the recommendations for non-pregnant women, with some modifications for pregnant women with abnormal screening results 1. For pregnant women who are due for screening, a Pap test with or without HPV testing should be performed at the initial prenatal visit. If the results are normal, no additional cervical cytology screening is needed during pregnancy.
Screening Recommendations
- Women under 21 years should not be screened for cervical cancer 1
- Women aged 21 to 29 years should undergo cytologic testing alone every 3 years 1
- Women aged 30 to 65 years should undergo cytologic and HPV cotesting every 5 years (preferred), or cytologic testing alone every 3 years (acceptable) 1
- 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 1
For abnormal screening results, colposcopy can be safely performed during pregnancy, preferably in the first or second trimester. However, endocervical curettage is contraindicated during pregnancy due to the risk of pregnancy complications 1. Cervical biopsies may be performed if there is suspicion of high-grade lesions or cancer, but diagnostic excisional procedures like LEEP or cone biopsy are generally deferred until after delivery unless invasive cancer is suspected 1. This approach balances the need for appropriate cancer screening while minimizing unnecessary interventions during pregnancy, as most cervical abnormalities do not progress rapidly during the gestational period, and definitive treatment can often safely wait until the postpartum period.
From the Research
Cervical Cancer Screening in Pregnancy: ACOG Guidelines
- The American College of Obstetricians and Gynecologists (ACOG) guidelines for cervical cancer screening in pregnancy are based on the principle of balancing the risks and benefits of screening and treatment during pregnancy 2.
- Cervical cancer is a relatively uncommon condition during pregnancy, but its incidence is expected to increase as more women delay childbearing 3.
- The management of abnormal cervical cytology results during pregnancy can be challenging, and ACOG guidelines recommend a careful approach to evaluation and management 2.
Key Recommendations
- Women with a high-grade cytological lesion, a repeated low-grade lesion, or with an equivocal cytology result and a positive human papillomavirus (HPV) test should be referred for colposcopy 4.
- The role of the colposcopist is to identify the source of the abnormal cells and to make an informed decision as to whether or not any treatment is required 4.
- Reflex testing for high-risk HPV types of women with atypical squamous cells (ASC) of undetermined significance with referral for colposcopy of women who test positive is a first option 4.
- Repeat cytology is a second possibility, and direct referral to a gynaecologist should be restricted to special circumstances 4.
Special Considerations
- Women with high-grade squamous intraepithelial lesion (HSIL) or atypical squamous cells, cannot exclude HSIL (ASC-H) should be referred without triage 4.
- Women with glandular lesions require particular attention, and their management should be individualized based on the specific circumstances of each case 4.
- Pregnant women with cervical cancer should be managed by a multidisciplinary team, including obstetricians, gynecologic oncologists, and other specialists as needed 3, 5.