Is a Pap (Papanicolau) smear recommended during pregnancy?

Pap Smear During Pregnancy

Pregnant women should undergo a Papanicolaou (Pap) test as part of routine prenatal care, following the same screening frequency recommendations as non-pregnant women. 1

Recommendations for Pap Smear During Pregnancy

• Pregnant women should be screened at the same frequency as non-pregnant women 2, 1
• The Pap smear should be performed as part of the initial prenatal evaluation if the woman has not had appropriate screening according to age-recommended intervals 1
• A cytobrush or swab with an Ayre's spatula can be used for obtaining Pap smears in pregnant women 2, 1

Technique Considerations

When performing a Pap smear during pregnancy, healthcare providers should:

• Take special care not to disrupt the cervical mucus plug 2, 1
• Perform the sampling gently but using standard technique 1
• Note that cytobrushes are considered safe by some guidelines 2 but not recommended by others 2, highlighting the importance of gentle technique

Clinical Significance

Pregnancy represents an excellent opportunity for cervical cancer screening, especially for women who may not regularly access healthcare. Research shows that the prevalence of abnormal pre-cancerous smears during pregnancy is low (0.8% in one study), but screening provides valuable preventive care 3.

Management of Results

• If results are abnormal, management protocols differ for pregnant women compared to non-pregnant women 2
• Women with high-grade squamous intraepithelial lesions (HSIL) or squamous cell carcinoma should be referred for colposcopy and directed biopsy 1
• Management of women with atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL) may vary according to local guidelines 1

Special Considerations

• The Pap test should be postponed if a woman is menstruating 2, 1
• Mucopurulent discharge may compromise interpretation but should not delay testing; the discharge can be carefully removed with a saline-soaked cotton swab before performing the test 2
• The sequence of Pap testing in relation to collection of other cervicovaginal specimens does not influence results or interpretation 2

Common Pitfalls to Avoid

1. Knowledge gaps among providers: Some healthcare providers may lack scientific knowledge about Pap smear testing during pregnancy, which can lead to missed opportunities for screening 4

2. Poor follow-up adherence: Studies show that adherence to follow-up recommendations for abnormal Pap smears can be low, highlighting the importance of effective reminder systems (up to 3 reminders) to ensure proper follow-up 5

3. Timing concerns: Some providers incorrectly believe that Pap smears during pregnancy may cause complications such as bleeding or miscarriage 4, but when performed properly, the procedure is safe

4. Postpartum timing: If screening is deferred until postpartum, be aware that the incidence of abnormal Pap smears increases as the postpartum interval decreases from 8 to 4 weeks, suggesting that later postpartum testing (6-8 weeks) may yield fewer false positives 6

By incorporating cervical cancer screening into routine prenatal care, healthcare providers can help ensure women receive this important preventive service while already engaged with the healthcare system.