Serati Maurizio, Uccella Stefano, Laterza Rosa M, Salvatore Stefano, Beretta Paolo, Riva Cristina, Bolis Pier Francesco
Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy.
Acta Obstet Gynecol Scand. 2008;87(12):1296-300. doi: 10.1080/00016340802482986.
It is uncertain whether pregnancy influences the natural history of cervical intraepithelial neoplasia (CIN). Our aim was to evaluate the evolution of CIN in pregnant women.
Prospective study.
Department of Obstetrics and Gynaecology, University of Insubria, Italy.
Women with histological CIN during pregnancy.
Between 2003 and 2007, women with an abnormal Pap-smear during pregnancy underwent colposcopy. Patients with histological CIN were followed during pregnancy with colposcopy every 8 weeks and post-partum evaluation was scheduled 3-6 months after delivery. Women with post-partum histological diagnosis of CIN 2-3 underwent conization. To understand the impact of pregnancy on the evolution of CIN, women with CIN 1 discovered during pregnancy were compared to a group of non-pregnant fertile patients with first diagnosis of CIN 1.
A total of 78 women were included: 36 (46.2%) with CIN 2-3 and 42 (53.8%) with CIN 1. In women with CIN 2-3, no invasion was suspected during pregnancy and at post-partum evaluation, no invasive or microinvasive cancer, and 19 (52.7%) persistent CIN 2-3, and 17 (47.3%) regressions were diagnosed. In the group of CIN 1, we recorded six (14.3%) progressions to CIN 2-3, seven (16.6%) persistent CIN 1 and 29 (69%) regressions. The control group of non-pregnant women had a lower regression rate (37/76: 48.7%) in comparison to pregnant women (p=0.03).
Expectant management for CIN 2-3 diagnosed during gestation is safe. When discovered during pregnancy, CIN 1 has a significantly higher tendency to spontaneous regression in comparison to non-pregnant condition.
妊娠是否会影响宫颈上皮内瘤变（CIN）的自然病程尚不确定。我们的目的是评估孕妇CIN的演变情况。
前瞻性研究。
意大利因苏布里亚大学妇产科。
孕期组织学诊断为CIN的女性。
2003年至2007年期间，孕期巴氏涂片异常的女性接受了阴道镜检查。组织学诊断为CIN的患者在孕期每8周进行一次阴道镜检查，并在产后3至6个月安排产后评估。产后组织学诊断为CIN 2-3的女性接受了锥形切除术。为了解妊娠对CIN演变的影响，将孕期发现CIN 1的女性与首次诊断为CIN 1的非妊娠育龄患者组进行了比较。
共纳入78名女性：36名（46.2%）为CIN 2-3，42名（53.8%）为CIN 1。CIN 2-3的女性在孕期及产后评估时均未怀疑有浸润，未诊断出浸润性或微浸润癌，19名（52.7%）为持续性CIN 2-3，17名（47.3%）为消退。在CIN 1组中，我们记录到6名（14.3%）进展为CIN 2-3，7名（16.6%）为持续性CIN 1，29名（69%）为消退。与孕妇相比，非孕妇对照组的消退率较低（37/76：48.7%）（p=0.03）。
妊娠期诊断为CIN 2-3的期待治疗是安全的。与非妊娠状态相比，孕期发现的CIN 1自发消退的倾向明显更高。
