Can a Pap smear be performed on a pregnant patient?

From the Guidelines

Pap smears can be safely performed during pregnancy, but they should be limited to women who are due for routine screening or have specific concerns, as recommended by the guidelines for cervical cancer screening 1. When performing a Pap smear on a pregnant patient, it's essential to take into account the increased vascularity of the cervix, which may lead to easier bleeding. However, this does not affect the accuracy of the test.

• The procedure for performing a Pap smear during pregnancy is generally the same as for non-pregnant patients, with care taken to avoid aggressive sampling of the cervix.
• If a Pap smear shows abnormalities during pregnancy, follow-up colposcopy can be performed, but cervical biopsies are usually deferred unless there's suspicion of invasive cancer, as outlined in the guidelines for colposcopy during pregnancy 1.
• Most providers prefer to perform Pap smears before 24 weeks gestation when possible, as the enlarged uterus and positioning can make the procedure more challenging later in pregnancy.
• After delivery, any necessary follow-up testing can be completed at the postpartum visit, and treatment for cervical intraepithelial neoplasia (CIN) should be delayed until after pregnancy, according to the guidelines 1. The main reason to perform Pap smears during pregnancy is that it provides an opportunity to detect cervical abnormalities in women who might not otherwise receive regular screening, and this can help improve morbidity, mortality, and quality of life outcomes for these patients.

From the Research

Pap Smear in Pregnant Women

• The study 2 suggests that pregnancy represents a unique opportunity to screen reproductive age women for cervical cancer, and abnormal cervical cytology is relatively common in this population.
• Consensus guidelines established by the American Society for Colposcopy and Cervical Pathology provide considerations for the management of cervical dysplasia in pregnant women.
• There is no direct evidence to suggest that a Pap smear cannot be performed on a pregnant woman, but the management of abnormal results may differ due to the pregnancy.

Diagnostic Techniques

• The study 3 compares the sensitivity and specificity of conventional Pap smear, liquid-based cytology, and colposcopy in detecting cervical lesions, with colposcopy showing the best efficacy.
• The study 4 evaluates the efficacy of Pap smear, HPV DNA testing, and colposcopy in cervical cancer screening, suggesting that combining Pap smear and HPV DNA testing can increase sensitivity and negative predictive value.
• The study 5 correlates the findings of Pap smear with colposcopy and directed biopsy, highlighting the usefulness of colposcopy in discovering premalignant and malignant lesions of the cervix.

Management of Abnormal Results

• The study 6 emphasizes the importance of colposcopy in evaluating abnormal cervical smears, allowing for the identification of the site, severity, and extent of abnormality, as well as directed biopsy and treatment planning.
• The study 2 reviews modalities for evaluation and management algorithms for cervical dysplasia in pregnant women, considering the unique aspects of pregnancy.