Screening for cervical cancer during pregnancy

Banumathy Manikkam


Background: Carcinoma cervix is the second most common gynaecological cancer causing deaths among women. PAP smear being most sensitive and specific screening test reducing mortality and morbidity, can be used to identify early changes in cervix during pregnancy. The aim of the study was to offer cervical cancer screening for pregnant women and motivate them into the mainstream of screening subsequently and evaluate their acceptance. Also to identify reproductive tract infections, associated pregnancy changes and their effect on pregnancy outcome. This prospective study enrolled 200 normal pregnant patients admitted at Sri Rama Krishna Hospital from September 2012 to January 2014.

Methods:All the patients selected for this study underwent history taking and examination .Pap smear was taken with patient in dorsal position. Among 200 cases, 196 (98%) were adequate smears and only 4 (2%) were inadequate. Adequate smears which were grouped as per Bethesda system, majority (97.5%) fell in Group I and were found to be normal or inflammatory smear, while only one showed ASCUS. Of the cases in Group I, 114 cases (57%) showed inflammation while 81 cases (40.5%) were normal. Statistical analysis used was SPSS 11.5.

Results: Majority of the patients involved in study were in the age group of 20-35years with only 3.5% below 19yrs and 2% above 35years with mean age of 26.9years. Most of the patients were married at 20-30yrs of age while only 4.5% were married after 30 with mean age of marriage 23.4yrs. Importantly 15% had an early marriage between 15-19yrs. Most of patients who consented for study belonged to third trimester (91.5%) followed second trimester (17%) with average of 32.7wks. About 80% had knowledge regarding screening for cervical cancer. Statistical analysis used was SPSS 11.5.

Conclusions:PAP smear being a cost effective, easy to perform test, can be carried out even in pregnant woman. It does not interfere with the natural course of pregnancy and hence safety is ensured. Pregnancy is a potential opportunity to counsel and educate them regarding the significance of screening. 


Pregnancy, PAP smear, Cervical cancer, Screening

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Arbyn M, Autier P, Ferlay J. Burden of cervical cancer in the 27 member states of the European Union: estimates for 2004. Ann Oncol. 2007;18(8):1423-5.

Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74-108.

Dinc A. Pap Smear Screening Results for Turkish Pregnant Women. Asian Pacific Journal of Cancer Prevention. 2012;13(11):5835-8.

Canfell K, Sitas F, Beral V. Cervical cancer in Australia and the United Kingdom: comparison of screening policy and uptake, and cancer incidence and mortality. Med J Aust. 2006;185:482-6.

Satija A. Cervical Cancer in India. South Asia Centre for Chronic Disease. (WHO, 2009b; GLOBOCAN 2002 database, IARC).

Guidelines for management of cervix cancer. Indian Council of Medical. Research, New Delhi. 2006.

Ngaojaruwong N, Vuthiwong C, Punpuckdeekoon P, Thongsorn N. Prevalence of Abnormal Papanicolaou Smear in Pregnant Women at Phramongkutklao Hospital. 2008;16(3):179.

Apgar BS, Kittendorf AL, Bettcher CM, Wong J, Kaufman AJ. Update On ASCCP Consensus Guidelines for Abnormal Cervical Screening Tests and Cervical Histology. Am Fam Physician. 2009;80(2):147-55.

Ueki M, Ueda M, Kumagai K, Okamoto Y, Noda S, Matsuoka M. Cervical Cytology And Conservative Management Of Cervical Neoplasias During Pregnancy. J Low Genit Tract Dis. 2009;13(3):182-5.

Priyadhashini M, Panicker S. Screening for Cervical in Pregnancy- Our Experience. Indian Journal of Public Health Research & development. 2013;4(3):202-6.

Sobel JD, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy PR, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. ‎1998

Vural E, Gonenc L, Aka N. Antenatal kontrollerde pap smear taraması ve Sonucları. Türkiye Aile Hekimligi Dergisi. 2004;8:111-5.

Siddiqui G, Kurzel RB, Lampley EC. Cervical dysplasia in pregnancy: progression versus regression post-partum. Int J Fertil Womens Med. 2001;46:278-80.

Bedrossian UK, Fairfax MR, Ayers M. Pap smear follow-up of mucopurulent exudate as a prognosticator of a negative pregnancy outcome. Diagn Cytopathol. 1999;21:00-00.

Singh R, Singh BS, Kaur P, Verma G, Kaur S. Contraceptive practices adopted by women attending an urban health centre in Punjab, India. Int J Res Dev health. 2013;1(3):115-9.

Patro BK, Kant S, Baridalyne N, Goswami AK. Contraceptive Practice Among Married Woman in a Resettlement colony of Delhi. Health and population. 2005;28(1):9-16.

Thapa S, Rani A, Mishra CP. Knowledge, Attitude and Belief about Contraception in post-partum and post abortal woman in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2014;3(3):533-9.