Should a Pap (Papanicolau) smear be performed during pregnancy?

Pap Smear During Pregnancy

Pregnant women should have a Pap smear as part of routine prenatal care, and should be screened at the same frequency as non-pregnant women. 1

Recommendations for Pap Smear Collection During Pregnancy

• A swab and an Ayre's spatula should be used for obtaining Pap tests in pregnant women, but cytobrushes are not recommended due to risk of disrupting the mucous plug 1
• If a woman is menstruating, the Pap smear should be postponed, and she should be advised to have a Pap smear at the earliest opportunity 1
• The presence of mucopurulent discharge should not delay the Pap test; the test can be performed after careful removal of the discharge with a saline-soaked cotton swab 1
• Pregnant women with external genital warts do not need Pap tests more frequently than pregnant women who do not have warts 1

Management of Abnormal Results During Pregnancy

• Management recommendations for abnormal Pap smears differ for pregnant women compared to non-pregnant women 1
• For pregnant women with abnormal Pap smears, colposcopy can be performed during pregnancy, but in many cases, definitive treatment can be deferred until after delivery 2
• Conservative management of women with atypical glandular cells (AGC) in pregnancy is safe when invasive cancer is excluded 3

Special Considerations

• Pregnancy provides a valuable opportunity to screen women who might not otherwise receive cervical cancer screening 2, 4
• The prevalence of premalignant lesions reported on Pap smear during pregnancy is relatively low (approximately 0.8%) 2
• Risk factors associated with abnormal Pap smears during pregnancy include young age (20-30 years), nulliparity, early coitarche, and multiple sexual partners 2, 5

HIV-Infected Pregnant Women

• HIV-infected pregnant women should follow the same cervical cancer screening recommendations as non-pregnant HIV-infected women 1
• HIV-infected women should have a cervical Pap smear performed upon initiation of care, repeated at 6 months, and if results are normal, annually thereafter 1
• Women with abnormal results (ASC-US, ASC-H, atypical glandular cells, low-grade or high-grade squamous intraepithelial lesion) should undergo colposcopy and directed biopsy 1

Clinical Pitfalls to Avoid

• Do not use cytobrushes for Pap smear collection in pregnant women as they may disrupt the mucous plug 1
• Do not delay Pap smear due to mucopurulent discharge; instead, carefully remove the discharge with a saline-soaked cotton swab before obtaining the specimen 1
• Do not assume that pregnancy exempts women from routine cervical cancer screening; pregnant women should be screened at the same frequency as non-pregnant women 1
• Do not miss the opportunity to screen women during pregnancy, as it may be their only contact with healthcare for extended periods 2, 5