A 29-year-old woman at 15 weeks of gestation undergoes a diagnostic cone biopsy for HSIL on Pap smear. Histology shows Stage IA1 squamous cell carcinoma with 2 mm stromal invasion, 5 mm horizontal spread, free margins and no lymphovascular space invasion. She strongly desires to continue the pregnancy. The most appropriate plan is:
- A Immediate radical hysterectomy with pelvic lymphadenectomy
- B Immediate pelvic external beam radiotherapy
- C Continue the pregnancy, deliver vaginally at term, then reassess with colposcopy postpartum ✓
- D Repeat cone biopsy at 20 weeks of gestation
Correct answer: C. Continue the pregnancy, deliver vaginally at term, then reassess with colposcopy postpartum
Explanation
Stage IA1 with free margins and no lymphovascular space invasion carries negligible risk of nodal spread, so pregnancy may safely continue with colposcopic surveillance each trimester and reassessment after delivery. Definitive management, typically repeat conization or simple hysterectomy depending on completion of childbearing, is deferred until the postpartum period. Radical surgery and radiotherapy are unwarranted for microinvasive disease and would sacrifice the pregnancy.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.