Pap Smear During Pregnancy
Yes, Pap smears can and should be performed on pregnant women at the same frequency as non-pregnant women, using appropriate collection techniques. 1, 2
Screening Recommendations
Pregnant women should undergo cervical cancer screening at the same intervals as non-pregnant women. 1, 2 Pregnancy provides an important opportunity for cervical cancer screening, particularly for women who may not otherwise access routine healthcare. 3
- Screening should be performed as part of routine prenatal care 2
- The same screening frequency applies regardless of pregnancy status 1
- HIV-infected pregnant women should have a Pap smear upon initiation of care, repeated at 6 months, and if normal, annually thereafter 1, 2
Collection Technique Modifications
Critical technical differences exist for Pap smear collection during pregnancy:
- Use a swab and Ayre's spatula for specimen collection 1, 2
- Cytobrushes are NOT recommended because they may disrupt the cervical mucous plug 1, 2
- Liquid-based cytology is an acceptable alternative to conventional Pap tests 1
Timing and Special Circumstances
The Pap test should be postponed if the woman is menstruating, and she should be advised to have the test at the earliest opportunity. 1, 2
Mucopurulent discharge should not delay testing:
- The test can be performed after careful removal of discharge with a saline-soaked cotton swab 1, 2
- Most Pap tests will be satisfactory for evaluation even in the presence of infection 1
Management Differences
While screening frequency remains the same, management of abnormal results differs in pregnant versus non-pregnant women. 1, 2 The primary goal during pregnancy is to exclude invasive cancer, not to definitively treat preinvasive lesions. 4
- Colposcopy with selective biopsy is performed only when high-grade lesions or cancer are suspected 2, 4
- Endocervical curettage and endometrial biopsy are contraindicated in pregnancy 4
- Definitive treatment is typically deferred until postpartum unless invasive cancer is diagnosed 4
Common Pitfalls to Avoid
Do not skip cervical cancer screening simply because a woman is pregnant - pregnancy does not exempt women from routine screening. 2
Do not use cytobrushes - this is the most critical technical error to avoid as it may disrupt the mucous plug. 1, 2
Do not delay the Pap test due to discharge - simply remove it carefully with a saline-soaked swab before collection. 1, 2
Be aware that Pap test results during pregnancy may be affected by hormonal changes, which can cause reactive cellular changes that may complicate interpretation. 5 However, this does not preclude performing the test, as the benefits of screening outweigh these limitations.