Cone biopsy during pregnancy

Under a diagnostic schema that used cervical conization liberally for evaluating women with abnormal Papanicolaou smears, 82 pregnant patients underwent conization. Fifteen had significant morbidity related to cervical bleeding. The uncorrected perinatal mortality was 44.1/1000. Sixty-one cone biopsies, performed before colposcopy was introduced into the schema, uncovered 2 cases of previously undiagnosed invasive carcinoma. Among 21 patients who underwent colposcopy before conization, 1 case of microinvasive carcinoma was diagnosed. During the study, 15 patients with frankly invasive carcinoma were identified, 9 by punch biopsy of a gross lesion, 2 by cone biopsy without prior colposcopy, and 4 by colposcopically directed punch biopsy. As a result of the review, the diagnostic schema has been changed so that biopsy is used less often on pregnancy patients.