Outcome of three consecutive inadequate cervical smears

A retrospective audit of women with three consecutive inadequate cervical smears during 1998-99 was conducted at Birmingham Heartlands Hospital. The commonest reasons were obscured by polymorphs (34.5%) and sparse cellularity (28.9%). Seventy-three per cent (73%) were followed up at colposcopy and 22.1% had histological assessment; 15.9% of women had an abnormality detected, 10.6% with abnormal histology and 5.3% with a cytological abnormality only. Cytological abnormalities were seen in 11.1% of the screening population. This study did not identify a cytological criterion to differentiate those that would or would not have an abnormality on follow-up. It is suggested that all women with three consecutive inadequate smears should have adequate follow-up, although this may place increased demands on colposcopy services.