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Screening for cervical neoplasia during pregnancy
H S Cronjé1, E van Rensburg, I Niemand
1Department of Obstetrics and Gynecology, University of the Orange Free State, Bloemfontein, South Africa. gnoghsc@med.uovs.ac.za
Summary
Cytology is not a reliable screening method for cervical neoplasia in pregnancy. Further testing is recommended due to low yield and poor agreement with other methods.
Area of Science:
- Obstetrics and Gynecology
- Oncology
- Public Health
Background:
- Cervical neoplasia screening is crucial for maternal and infant health.
- Pregnancy presents unique challenges for effective cervical cancer screening.
Purpose of the Study:
- To assess the effectiveness of cytology for detecting cervical neoplasia during pregnancy.
- To compare cytology with cervicography and the acetic acid test (AAT) in pregnant women.
Main Methods:
- A study involving 842 pregnant women in South Africa.
- Simultaneous screening using cytology, cervicography, and AAT.
- Statistical analysis including kappa statistic to measure agreement between tests.
Main Results:
- Cytology detected abnormalities in 1.4% of cases, cervicography in 6.3%, and AAT in 14.3%.
- Very low agreement was observed between cytology and cervicography (kappa=0.01), and cytology and AAT (kappa=0.0).
- Cervicography and AAT showed moderate agreement (kappa=0.2).
Conclusions:
- Cytology has a low yield for detecting cervical neoplasia in pregnant women.
- The poor agreement between cytology and other screening methods suggests it should be combined with an additional test.
- Supplementing cytology with another screening modality is recommended for improved detection during pregnancy.