Gonçalves Carla Vitola, Duarte Geraldo, Costa Juvenal Soares Dias da, Marcolin Alessandra Cristina, Bianchi Mônia Steigleder, Dias Daison, Lima Luis Cláudio de Velleca e
Mother-Child Department, Universidade Federal do Rio Grande, Rio Grande, Rio Grande do Sul, Brazil.
Sao Paulo Med J. 2009 Nov;127(6):359-65. doi: 10.1590/s1516-31802009000600008.
One third of all cervical carcinomas occur during the reproductive period. Cervical carcinoma is the second greatest cause of death due to cancer during this phase. The estimated frequency of cervical cancer during pregnancy is one case for every 1,000 to 5,000 pregnancies. The aim here was to provide information about the difficulties in diagnosing and managing cervical neoplasia during pregnancy.
A systematic review of the literature was undertaken through the PubMed, Cochrane, Excerpta Medica (Embase), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO) databases, using the following words: pregnancy, cervical cancer, diagnosis and management.
There was a consensus in the literature regarding diagnosis of cervical carcinoma and management of preneoplastic lesions during pregnancy. However, for management of invasive carcinoma, there was great divergence regarding the gestational age taken as the limit for observation rather than immediate treatment.
All patients with cytological abnormalities should undergo colposcopy, which will indicate and guide biopsy. Conization is reserved for patients with suspected invasion. High-grade lesions should be monitored during pregnancy and reevaluated after delivery. In cases of invasive carcinoma detected up to the 12th week of pregnancy, patient treatment is prioritized. Regarding diagnoses made during the second trimester, fetal pulmonary maturity can be awaited, and the use of chemotherapy to stabilize the disease until the time of delivery appears to be viable.
所有宫颈癌中有三分之一发生在生育期。宫颈癌是该时期因癌症导致死亡的第二大原因。孕期宫颈癌的估计发病率为每1000至5000次妊娠中有1例。本文旨在提供有关孕期宫颈癌前病变诊断和管理困难的信息。
通过PubMed、Cochrane、医学文摘数据库（Embase）、拉丁美洲和加勒比卫生科学文献数据库（Lilacs）以及科学电子图书馆在线数据库（SciELO）对文献进行系统综述，使用以下关键词：妊娠、宫颈癌、诊断和管理。
文献中对于孕期宫颈癌的诊断和癌前病变的管理存在共识。然而，对于浸润性癌的管理，在以何孕周作为观察而非立即治疗的界限方面存在很大分歧。
所有细胞学异常的患者均应接受阴道镜检查，这将指导活检。锥形切除术适用于疑似浸润的患者。高级别病变在孕期应进行监测，并在产后重新评估。在妊娠12周内检测到浸润性癌的病例中，优先考虑患者治疗。对于在孕中期做出的诊断，可以等待胎儿肺成熟，并且使用化疗来稳定病情直至分娩似乎是可行的。
