Timing of the postpartum Papanicolaou smear

To study the relation between the timing of the postpartum examination and the postpartum Papanicolaou smear.

One hundred eighty-four women in labor at Arlington Community Hospital were randomized to receive their postpartum Papanicolaou smear at 4, 6, or 8 weeks after delivery. Samples from the exocervix and endocervix were obtained and submitted to the pathology department, which was unaware of the study.

Twenty-three women were lost to follow-up. Among 161 women who had a postpartum examination, 48 (30%) had it at 4 weeks, 61 (38%) at 6 weeks, and 52 (32%) at 8 weeks. The groups were similar with respect to age, ethnicity, gravidity, parity, marital status, number of sexual partners, age at first intercourse, history of cervical infections, previous history of abnormal Papanicolaou smears, and cervical surgery. Among the 139 women who had a normal prenatal smear, 26 (59%) had an abnormal smear at 4 weeks (24 [92%] had inflammation, one [4%] had inflammation with nuclear atypia, and one [4%] had cervical intraepithelial neoplasia [CIN] III), 17 (32%) were abnormal at 6 weeks (15 [88%] had inflammation, one [6%] had inflammation with nuclear atypia, and one [6%] had CIN III), and 12 (28%) were abnormal at 8 weeks (11 [92%] had inflammation and one [8%] had inflammation with nuclear atypia). There were no differences in the distribution of abnormal Papanicolaou smears at the repeat smear done 3 months after the postpartum examination.

The incidence of abnormal Papanicolaou smears increased as the postpartum interval decreased from 8 to 4 weeks.