Does a pap (Papanicolaou) smear pose risks to pregnancy?

Pap Smear Safety During Pregnancy

Pap smears are safe during pregnancy and do not pose risks to the pregnancy. 1

Recommendations for Pap Smear Collection During Pregnancy

• Pregnant women should have a Pap smear as part of routine prenatal care and should be screened at the same intervals as non-pregnant women 2, 1
• A swab or Ayre's spatula should be used for obtaining Pap tests in pregnant women 2, 1
• While some guidelines indicate cytobrushes can be used with care during pregnancy, others recommend avoiding them due to theoretical risk of disrupting the mucous plug 2, 1
• If a woman is menstruating, the Pap smear should be postponed until bleeding stops 2, 1
• Pap smear collection during pregnancy is considered necessary, safe, and acceptable as part of routine prenatal care 3

Timing and Technique

• Pap smears should be performed at the first prenatal visit if none has been documented during the preceding year 2
• Care should be taken during specimen collection to avoid disrupting the mucous plug 2
• The presence of mucopurulent discharge should not delay the Pap test; the discharge can be carefully removed with a saline-soaked cotton swab before obtaining the specimen 1
• Pregnant women with external genital warts do not need Pap tests more frequently than pregnant women without warts 2, 1

Benefits of Screening During Pregnancy

• Pregnancy provides a valuable opportunity to educate and screen women for cervical cancer when they are already receiving prenatal care 4
• The prevalence of abnormal pre-cancerous smears during pregnancy is relatively low (0.8-0.94% according to studies), but screening provides an opportunity that might otherwise be missed 3, 5
• Early detection of cervical abnormalities during pregnancy allows for appropriate follow-up and management 4

Management of Abnormal Results

• Management recommendations for abnormal Pap smears differ for pregnant women compared to non-pregnant women 1
• For pregnant women with minor Pap abnormalities, postponing colposcopy until after delivery is now considered acceptable 4
• If a Pap smear shows severe inflammation with reactive cellular changes, the woman should be advised to have another Pap smear within 3 months 2

Special Populations

• HIV-infected pregnant women should follow the same cervical cancer screening recommendations as non-pregnant HIV-infected women 2, 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 2, 1
• Women with abnormal results should undergo appropriate follow-up, which may include colposcopy and directed biopsy 1

Clinical Pitfalls to Avoid

• Do not assume that pregnancy exempts women from routine cervical cancer screening 1
• Do not delay Pap smear due to mucopurulent discharge; instead, carefully remove the discharge before obtaining the specimen 1
• Be aware that normal pregnancy-related cellular changes can sometimes be confused with atypical findings, requiring experienced cytopathology interpretation 6

In conclusion, Pap smears are safe during pregnancy and remain an important part of prenatal care. The collection technique should be modified slightly to ensure safety, but the screening itself poses no risk to the pregnancy when performed properly.