Risk of Miscarriage After Pap Smear During Pregnancy
There is no evidence that Pap smears increase the risk of miscarriage during pregnancy. Pap smears are considered safe during pregnancy and can be performed when clinically indicated.
Safety of Pap Smears During Pregnancy
Pap smears (Papanicolaou tests) are routine screening procedures for cervical cancer that involve collecting cells from the cervix. The available evidence does not suggest any increased risk of miscarriage associated with this procedure:
- No guidelines or research studies indicate that Pap smears cause miscarriage
- The procedure is non-invasive and does not disturb the pregnancy
- The speculum examination component of a Pap test does not enter the uterus where the pregnancy is located
Background Risk of Miscarriage
To put this in perspective, it's important to understand the baseline risk of miscarriage in pregnancy:
- For asymptomatic women after confirmation of fetal viability by ultrasound, the overall risk of miscarriage is approximately 1.6% 1
- This risk decreases with advancing gestational age: 9.4% at 6 weeks, 4.2% at 7 weeks, 1.5% at 8 weeks, 0.5% at 9 weeks, and 0.7% at 10 weeks 1
Pap Smear Guidelines During Pregnancy
While Pap smears don't increase miscarriage risk, here are the current recommendations regarding Pap tests during pregnancy:
- Routine screening Pap tests can be safely performed during pregnancy if due according to standard screening intervals
- Pregnancy is not a reason to change the regular screening schedule
- If a woman is due for her routine Pap test and happens to be pregnant, the test can generally be performed safely during the prenatal visit
Considerations for Pap Smears in Pregnancy
Some practical considerations when performing Pap smears during pregnancy include:
- The cervix has increased vascularity during pregnancy, which may lead to minor spotting after the procedure (this is not harmful to the pregnancy)
- Some providers prefer to perform Pap tests in the first or second trimester rather than later in pregnancy for patient comfort
- If abnormal results are found, follow-up colposcopy can generally be performed safely during pregnancy 2
Prevalence of Abnormal Results
A study examining Pap smears during pregnancy found:
- Approximately 6% of pregnant women had abnormal Pap smear results 3
- The most common abnormal finding was low-grade squamous intraepithelial lesion (LSIL) 3
Conclusion
Healthcare providers can reassure pregnant women that Pap smears do not increase the risk of miscarriage. The procedure is safe during pregnancy and can be performed when clinically indicated according to standard screening guidelines.