Cervical screening in pregnancy

The cervical screening test should be postponed in a pregnant woman whose previous test was normal and who has been called for routine screening (1).

If a woman becomes pregnant since the last test and if this last test was abnormal, cervical sample should not be delayed but it should be obtained in the mid-trimester unless there is a contraindication (1).

If a pregnant woman requires colposcopy or cytology after treatment (or follow up of untreated CIN 1), her assessment may be delayed until after delivery.

Unless there is an obstetric contraindication, however, assessment should not be delayed if a first follow up cytology or colposcopy is required following treatment for cervical glandular intraepithelial neoplasia (cGIN), or treatment for CIN 2/3 with involved or uncertain margin status. The colposcopist may wish to perform only colposcopy at a follow up appointment in pregnancy. If repeat cytology is due, and the woman has missed or defaulted her appointment prior to pregnancy, consideration should be given to her having the cytology or colposcopy during pregnancy.

Colposcopy in pregnancy:

• colposcopic evaluation of the pregnant woman requires a high degree of skill
  • if CIN 1 or less is suspected, repeat the examination three months following delivery
  • if CIN 2 or 3 is suspected, repeat colposcopy at the end of the second trimester or, if the pregnancy has already advanced beyond that point, three months following delivery
  • if invasive disease is suspected clinically or colposcopically, a biopsy adequate to make the diagnosis is essential. Cone, wedge and diathermy loop biopsies are all associated with a risk of haemorrhage and such biopsies should be taken where appropriate facilities to deal with haemorrhage are available. Punch biopsy suggesting only CIN cannot reliably exclude invasion

Reference:

• 1. NHS Cancer Screening Programmes 2010. Colposcopy and programme management. Guidelines for the NHS cervical screening programme 2nd edition