| Clinical management and follow-up of squamous intraepithelial cervical lesions during pregnancy and postpartum. | |
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MedLine Citation:
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PMID: 17695441 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The incidence of cervical cancer in pregnancy is estimated to be 1-10/10000 pregnancies. Approximately 3% of cervical cancers are diagnosed during pregnancy. The incidence of abnormal Pap smears has been reported to be 5%-8%. Data on the spontaneous evolution of an intraepithelial neoplasia during pregnancy are quite diverse. Of dysplasia cases diagnosed during pregnancy, 10%-70% regress and sometimes even disappear postpartum, while persistence in the severity of cervical neoplasia is reported in 25%-47% and progression occurs in 3%-30%. However, adequate follow-up and definitive management in the postpartum period is important. The objective of the study was to assess proper management of squamous intraepithelial lesion (SIL) during and after pregnancy, to assess regression, persistence and risk of progression and the predictive role of HPV tests. MATERIALS AND METHODS: Thirty-one out of 721 pregnant women with a diagnosis of low- and high-grade SIL were observed. All patients were triaged using standard colposcopy. The histological diagnosis was assessed by colposcopic direct biopsies. In patients affected by high-SIL with colposcopic findings of suspected micro-invasive lesions, a loop electrosurgical excisional procedure (LEEP) was carried out in pregnancy. High risk HPV tests were performed using PCR. The patients were followed up with cytology and colposcopy every 6-8 weeks during gestation and nine weeks postpartum. They were re-evaluated using cytology, colposcopy and histology for a final diagnosis and, when necessary, submitted to treatment. The patients were followed up for a minimum of 5 years. The HPV test was performed once at 6-8 weeks during gestation and annually during the follow-up. RESULTS: Of the 31 patients with abnormal cytology, histological analysis revealed 10 cervical intraepithelial neoplasia (CIN) 1, 5 CIN 2 and 16 CIN 3. The HPV test at diagnosis was positive for HPV 16 type in 22 cases and negative in 9. Five patients with CIN 2 and 11 with CIN 3 were followed up; 5 patients with CIN 3 with colposcopic findings of suspected microinvasive lesions were submitted to an excisional procedure with LEEP before the 16th week of pregnancy. CONCLUSION: Performing high-risk HPV tests may improve the follow-up of patients with SIL in pregnancy and postpartum in addition to cytology and colposcopy to indicate persistence/progression of the lesions. Proper management and adequate follow-up could be proposed in pregnancy and postpartum. |
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Authors:
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Antonio Frega; Paolo Scirpa; Roberto Corosu; Monica Verrico; Maria Lisa Scarciglia; Maria Rita Primieri; Antonella Palazzo; Roberto Iacovelli; Massimo Moscarini |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anticancer research Volume: 27 ISSN: 0250-7005 ISO Abbreviation: Anticancer Res. Publication Date: 2007 Jul-Aug |
Date Detail:
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Created Date: 2007-08-15 Completed Date: 2007-08-23 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8102988 Medline TA: Anticancer Res Country: Greece |
Other Details:
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Languages: eng Pagination: 2743-6 Citation Subset: IM |
Affiliation:
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Department of Gynecology, Perinatology and Childhealth, University "La Sapienza" Rome, Italy. a.frega@tin.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Cervical Intraepithelial Neoplasia / pathology, surgery* Electrosurgery / methods Female Follow-Up Studies Humans Postpartum Period Pregnancy Pregnancy Complications, Neoplastic / pathology, surgery* Uterine Cervical Neoplasms / pathology, surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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