Department of Gynecology and Obstetrics, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Arch Gynecol Obstet. 2020 Jun;301(6):1503-1512. doi: 10.1007/s00404-020-05518-1. Epub 2020 Apr 22.
Management of high-grade cervical intraepithelial neoplasia [CIN grade 2 or 3 (CIN2-3)] diagnosed during pregnancy is controversial. Monitoring with colposcopy and cytology every 8-12 weeks is advised by the most current guidelines.
This study analyzes the course of disease in pregnant women with abnormal cytologies or clinically suspicious cervixes.
In total, 139 pregnant women, at a median age of 31 years (range 19-49), treated at the Colposcopy Unit of the University Medical Center Hamburg-Eppendorf between 2011 and 2017 were identified. During pregnancy, at least one biopsy was performed on 70.5% of patients. In 84.7% of cases, CIN2-3 (CIN2 n = 14 (14.3%), CIN3 n = 69 (70.4%)) was detected, 7.1% (n = 7) of women were diagnosed with CIN1, while no dysplasia was found in 8.2% (n = 8) of cases. No interventions were necessary during pregnancy. Despite explicit invitation, only 72.3% of women with CIN2-3 attended postpartal consultations. While 61.7% showed persistent lesions, 5% were diagnosed with CIN1 and 33.3% with complete remission. During pregnancy, 68.7% of women with prepartal CIN2-3 were tested for HPV infection. Later, 49.1% were followed up postpartally by means of HPV testing and histology. HPV clearance was observed in 36.4% of women with complete histological remission. Postpartum conization was performed on 44.6% of patients with prepartal CIN2-3 diagnosis. CIN2-3 was histologically confirmed in 97.3% cases. Progression from persistent CIN3 to microinvasive carcinoma was observed in a single case.
High-grade CIN lesions, diagnosed during pregnancy, show a high rate of regression postpartum; whereas, progression to carcinoma is rare. Close and continuous monitoring rarely has any therapeutic consequences. Compliance for postpartal follow-up needs to be improved.
妊娠期间诊断出高级别宫颈上皮内瘤变[CIN 2 级或 3 级（CIN2-3）]的处理存在争议。目前的指南建议每 8-12 周通过阴道镜检查和细胞学检查进行监测。
本研究分析了在妊娠期间细胞学异常或宫颈临床可疑的孕妇的疾病进程。
共确定了 2011 年至 2017 年期间在汉堡埃彭多夫大学医学中心阴道镜检查科就诊的 139 名中位年龄为 31 岁（19-49 岁）的孕妇。在妊娠期间，至少对 70.5%的患者进行了一次活检。在 84.7%的病例中，检测到 CIN2-3（CIN2n=14（14.3%），CIN3n=69（70.4%）），7.1%（n=7）的妇女被诊断为 CIN1，而在 8.2%（n=8）的病例中未发现发育不良。妊娠期间无需干预。尽管明确邀请，但只有 72.3%的 CIN2-3 妇女参加了产后咨询。尽管 61.7%的患者持续存在病变，但 5%被诊断为 CIN1，33.3%的患者完全缓解。妊娠期间，68.7%的产前 CIN2-3 妇女接受了 HPV 感染检测。之后，49.1%的妇女通过 HPV 检测和组织学进行产后随访。在完全组织学缓解的妇女中，36.4%的人观察到 HPV 清除。对 44.6%的产前 CIN2-3 诊断患者进行了产后锥切。97.3%的病例组织学证实为 CIN2-3。在单个病例中观察到持续性 CIN3 进展为微浸润癌。
妊娠期间诊断出的高级别 CIN 病变，产后消退率较高；而进展为癌的情况罕见。密切和持续监测很少有任何治疗后果。需要提高产后随访的依从性。
