Cervical intraepithelial neoplasia grade 2/3: development during pregnancy and postpartum

Objectives The aims of the this study were to evaluate the development of cervical intraepithelial neoplasia (CIN) 2/3 during pregnancy and to assess persistence, progression, and regression rates postpartum in order to identify factors associated with regression or progression.

Methods In a certified dysplasia unit of the university hospital Erlangen, a total of 174 pregnant women with CIN 2/3 were treated in the dysplasia unit. The follow-up findings were analyzed retrospectively based on histological, cytological, and HPV testing of 174 pregnant women confirmed as having CIN 2/3 in colposcopically guided biopsies.

Results The rates of persistence, regression, and progression of CIN 2/3 in these women were 73%, 20.7%, and 6.3%, respectively. The rate of regression was almost twice as high with vaginal delivery as with cesarean section, at 27.7% vs. 14.5%, whereas the rate of progression was lower with vaginal delivery, at 4.8% vs. 10.9% ([Tab. 1]).

Tab. 1

Antepartum	Postpartum
	Benign	CIN 1	CIN 2	CIN 3	AIS	Carcinoma
CIN 2 (n = 16)	1 (6.25%)	3 (18.75%)	7 (43.75%)	5 (31.25%)	0	0
CIN 3 (n = 154)	11 (7.1%)	12 (7.7%)	8 (5.2%)	118 (76.1%)	0	5 (3.2%)
AIS (n = 4 )	1 (25%)	0	0	0	2 (50%)	1 (25%)

Conclusion The rate of persistence of CIN observed in this study is comparable to that reported in other studies. The study provides strong evidence for greater regression among women who have vaginal deliveries. Careful follow-up is recommended postpartum in order to rule out persistent CIN 2/3 or invasive cervical cancer.

Publikationsverlauf

Artikel online veröffentlicht:
11. Oktober 2022