Colposcopic management of abnormal cervical cytology in pregnancy

Two hundred sixty-five pregnant women with abnormal Papanicolaou smears underwent colposcopy; 248 of them underwent directed cervical biopsies. Correlation of cytology with histology indicated concordancy within one grade in 202 of 241 patients (84%). Cytology was significantly more advanced than directed cervical biopsy in 15% and significantly less advanced in 1%. None of the 163 patients with moderate dysplastic cytology or less had microinvasive or invasive disease. Cervical conization was performed on 23 women, 4 of whom underwent modified radical hysterectomy for microinvasive carcinoma. Sixteen of 18 patients undergoing conization in pregnancy were available for postpartum follow-up and had persistent cervical dysplasia. Of 242 women followed conservatively, without pregnancy conization, 88 underwent postpartum evaluation. There were no false negatives in the antepartum evaluation of malignancy.