doiSerbia

Assessment of the natural course and treatment of premalignant uterine cervical lesions in pregnancy

Šljivančanin Dragiša (Klinički centar Srbije, Klinika za ginekologiju i akušerstvo, Beograd)
Kesić Vesna (Klinički centar Srbije, Klinika za ginekologiju i akušerstvo, Beograd)
Tulić Lidija (Klinički centar Srbije, Klinika za ginekologiju i akušerstvo, Beograd)
Dotlić Jelena (Klinički centar Srbije, Klinika za ginekologiju i akušerstvo, Beograd)

Introduction. Premalignant changes of the uterine cervix occur with similar frequency during pregnancy and in non­pregnant women. Due to the fact that any surgery on the cervix can jeopardize pregnancy, it is important to define the protocol of procedures for the treatment of these changes during pregnancy. Objective. The aim of the study was to investigate the natural course of premalignant cervical changes during pregnancy and the impact of their treatment on the pregnancy course. Methods. Study involved all patients with colposcopically, cytologically and hystopathologically diagnosed premalignant cervical changes during pregnancy from 2002 to 2008. Patients were divided into two groups according to the applied treatment during pregnancy: surgery or monitoring by regular colposcopic and cytological examinations. The two groups were compared concerning treatment outcome, persistence or regression of changes and pregnancy duration. Results. Study involved 58 patients. Spontaneous remission of lesions occurred after pregnancy in 63.79% of cases. Highgrade squamous intraepithelial lesion (H­SIL) demonstrated a higher rate of persistency in comparison with low­grade squamous intraepithelial lesion (L­SIL) (χ2=25.115; p<0.05). Only one finding of L­SIL progressed into H­SIL in the monitored group. Patients who underwent conization during pregnancy had a significantly more frequent preterm deliveries (χ2=14.369; p<0.05). Conclusion. The obtained high rate of spontaneous regression of cervical changes after pregnancy as well as the lower incidence of preterm births in patients who were not treated by conization during pregnancy, confirm that patients with premalignant cervical changes should be, if invasion is excluded, under follow­up throughout pregnancy by regular colposcopic and cytological examinations. Therapeutic conization, due to numerous complications, should be performed only when there is a suspected presence of a more severe form of the disease (micro invasive and invasive carcinoma).

Keywords: cervical intraepithelial neoplasia (CIN), pregnancy, treatment