Is a colposcopy (colposcopic examination) safe during pregnancy?

Colposcopy During Pregnancy: Safety and Management

Colposcopy is safe during pregnancy and should be performed when high-grade neoplasia or invasive cancer is suspected, while colposcopy for low-grade abnormalities (LSIL and ASC-US) can be deferred until 6 weeks postpartum. 1

Safety Considerations for Colposcopy in Pregnancy

Colposcopy during pregnancy has specific safety parameters that differ from non-pregnant patients:

• Safe procedures during pregnancy:

  • Colposcopic examination itself is safe 1, 2
  • Brush cytology is safe 1
  • Targeted cervical biopsies are safe when necessary 3

• Procedures to avoid during pregnancy:

  • Endocervical curettage (ECC) should NOT be performed 1
  • Treatment for cervical intraepithelial neoplasia (CIN) should be delayed until after pregnancy 1, 3
  • Excisional procedures (like LEEP or cold-knife conization) should be avoided unless invasive cancer is suspected 1

Indications and Management Algorithm

When to Perform Colposcopy During Pregnancy:

1. Immediate colposcopy indicated:

   • High-grade squamous intraepithelial lesion (HSIL) 1
   • Atypical squamous cells, cannot exclude HSIL (ASC-H)
   • Suspected invasive cancer
   • Atypical glandular cells (AGC)

2. Colposcopy can be deferred until 6 weeks postpartum:

   • Low-grade squamous intraepithelial lesion (LSIL) 1, 4
   • Atypical squamous cells of undetermined significance (ASC-US) 1, 4

Management Protocol:

1. For high-grade abnormalities:

   • Perform colposcopy by an experienced colposcopist 1, 2
   • Biopsy only if high-grade neoplasia or invasion is suspected 1
   • Follow with surveillance every 12-24 weeks until delivery 3
   • Defer treatment until postpartum 1, 3

2. For low-grade abnormalities:

   • Defer colposcopy until 6 weeks postpartum 1, 4
   • If colposcopy is performed during pregnancy, additional examinations during pregnancy are unnecessary if no CIN 2/3 or cancer is found 1

Special Considerations

Physiological Changes Affecting Colposcopy in Pregnancy:

• Increased cervical mucus production
• Cervical hyperemia and edema
• Gland prominence
• Eversion of columnar epithelium 2

These changes may make lesions appear more prominent and can complicate the examination, requiring expertise in interpreting colposcopic findings during pregnancy 2.

Biopsy Considerations:

• Although biopsies may subjectively be associated with increased bleeding, studies show they do not increase pregnancy complications 3
• Biopsies should be limited to cases where high-grade disease or invasion is suspected 1

Natural History of CIN During Pregnancy:

• CIN typically remains stable or regresses during pregnancy 3, 5
• Progression during pregnancy is uncommon 6
• Conservative management with appropriate follow-up is safe 6

Referral Recommendations

Due to the complexity of colposcopic evaluation during pregnancy, consultation with or referral to an experienced colposcopist should be considered 1, 2.

Key Pitfalls to Avoid

1. Performing endocervical curettage (ECC) during pregnancy
2. Treating CIN during pregnancy
3. Performing excisional procedures unless invasive cancer is suspected
4. Failing to refer to an experienced colposcopist
5. Overinterpreting physiological changes of pregnancy as pathological findings

By following these guidelines, colposcopy can be safely performed during pregnancy when indicated, while minimizing risks to both mother and fetus.