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Management and course of histologically verified cervical carcinoma in situ during pregnancy
S Ackermann1, C Gehrsitz, G Mehlhorn
1Department of Obstetrics and Gynecology, University-Hospital Erlangen, Germany. sven.ackermann@gyn.imed.uni-erlangen.de
Background:
To study the rate of regression and progression into invasive disease of patients with histologically proven carcinoma in situ of the uterine cervix during pregnancy.
Methods:
Prospective observation of all pregnant women with biopsy-proven carcinoma in situ of the uterine cervix, gained by colposcopic guided biopsy from 1996 to 2004 and correlation with the route of delivery and cytologic and histologic postpartum findings.
Results:
Eighty-three patients with histologically verified carcinoma in situ during pregnancy were treated conservatively. Two patients were lost to follow-up, one patient had an abortion, and three are still pregnant. The study population of 77 patients were followed for a median of 140 days before delivery. Postpartum regression rate was 34.2%, two patients had a diagnosis of microinvasive cervical cancer on the postpartum cone biopsy, and persistent carcinoma in situ was found postpartum in 63.1% of patients. No difference was seen for the route of delivery. Both patients with microinvasive carcinoma were delivered by primary cesarean section and are disease-free after 24 and 38 months, respectively.
Conclusions:
We recommend conservative management for women with carcinoma in situ of the uterine cervix. We found no difference for the route of delivery regarding postpartum regression and recommend a postpartum evaluation after the puerperium. Colposcopic guided biopsy should rule out an invasive process during pregnancy. Cesarean section as the mode of delivery should be considered, if invasion is suspected.