In cervical intraepithelial neoplasia (CIN) management, a Pap smear showing HSIL in a 28-year-old pregnant woman at 18 weeks is followed by colposcopy confirming CIN 2. What is the most appropriate management?
- A Repeat colposcopy and Pap smear every 12 weeks during pregnancy; defer treatment to 6–8 weeks postpartum ✓
- B LLETZ (large loop excision of transformation zone) immediately to prevent progression
- C Cone biopsy at 18 weeks to exclude invasive cancer
- D Cryotherapy of the transformation zone during pregnancy
Explanation
CIN 2 (moderate dysplasia) in a pregnant woman can be managed expectantly because: CIN regresses in up to 60–70% of cases postpartum, invasive cancer developing from CIN 2 during the 9 months of gestation is very uncommon, and procedural complications (miscarriage, preterm labor, hemorrhage) of LLETZ/cone biopsy in pregnancy are significant. Management involves colposcopic and cytological follow-up every 12 weeks during pregnancy. Colposcopy and directed biopsy are repeated only if there is suspicion of progression to invasive cancer; definitive treatment is deferred to 6–8 weeks postpartum. If invasive cancer is confirmed, management depends on stage and gestational age. Cryotherapy is not appropriate for CIN 2.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.