Comparison of Cervical HSIL Outcome between Pregnant and Non-Pregnant Women

Variables predicting outcome of high-grade squamous intraepithelial lesion (HSIL) in pregnancy are unknown. The HSIL is usually managed conservatively during pregnancy. We aim to assess morphological features of HSIL diagnosed during pregnancy and identify variables predicting HSIL outcome in pregnant and non-pregnant women.

ThinPrep pap smears with HSIL in pregnant (2014-2019) and non-pregnant females (2017-2019) were identified. The pathology material from follow-up cervical samples was reviewed by two participating pathologists (TP and KS). Regression was defined as benign or residual low-grade squamous intraepithelial lesion. Histological findings were recorded and compared between pregnant and non-pregnant cohort.

The HSIL regression rate was higher in colposcopic samples (16% vs. 0%; p=0.05) and follow up excisions (27% vs. 23%) from pregnant cohort. Overall regression rate was higher in pregnant versus non-pregnant cohort (34% vs. 23%; p=0.1). The stromal inflammation was prominent in biopsies from pregnant cohort (p=0.02). Presence of CIN 2 (versus CIN 3) in non-pregnant cohort predicted HSIL regression (p=0.04). The time to biopsy and excision (from pap smear) was significantly higher in pregnant cohort (p=0.0001). HSIL histological features (nuclear pleomorphism, hyperchromasia, nuclear contour irregularity, nuclear to cytoplasmic ratio, and mitosis) and HPV types were similar in both cohorts and did not predict regression.

The higher rate of benign findings during HSIL follow up in pregnancy is likely related to duration and stromal inflammation. HSIL regression is frequently noted following CIN2 diagnosis in non-pregnant setting. HSIL histology is similar in postpartum and non-pregnant females.