Many women with no health insurance undergo medical evaluations only when they are pregnant, and, in the current healthcare crisis, this may be the only time that they are eligible for cervical screening. The management of any cervical abnormality found in these patients can pose significant clinical problems for the physician and patient. To investigate the natural history of cervical abnormalities during pregnancy and to improve the management of pregnant patients with abnormal cervical cytology, the authors conducted a retrospective review of 292 pregnant patients who underwent colposcopy for evaluation of abnormal Pap smears in a suburban county hospital with a high percentage of uninsured patients.At the time of the initial smear, the women were an average of 26 years old and had a mean gestational age of 16.6 weeks. Eleven percent of the patients had cervical smears showing atypical squamous cells of unknown origin, 61 percent had low-grade squamous intraepithelial lesions (LGSIL), and 24 percent had high-grade squamous intraepithelial lesions (HGSIL). Cytologic findings suggestive of invasive cancer were seen in two patients (1 percent).The initial colposcopic examination was performed at an average of 24 weeksrsquo; gestation. Forty-one percent of the patients (Nequals; 119, including 38 with LGSIL and 11 with HGSIL) had only minor cervical changes identified by colposcopy. Thirty-five patients (12 percent) had evidence of human papillomavirus (HPV) infection, and 53 (18 percent) had a normal-looking cervix. Major changes were seen in 47 patients (16 percent), and atypical vessels were found in 14 patients (5 percent). Patients were managed according to their worst colposcopic diagnosis.A directed biopsy was performed in 27 (9 percent) women, 10 of whom had a colposcopic impression of grade 2 or 3 cervical intraepithelial neoplasia (CIN) (biopsy-proven CIN2 or CIN3 was found in only four), and three of whom had white lesions before the application of acetic acid. No reason for biopsy was identified for 14 women. None of the biopsies showed carcinoma. Of the 61 patients with an initial colposcopic impression of CIN2 or CIN3, only 10 underwent biopsy.Postpartum follow-up information was available for 123 women. Inflammatory, HPV, or CIN1 changes were found in 34 patients (28 percent), and CIN2 or CIN3 was seen in 54 women (42 percent). Invasive squamous carcinoma was found in one patient whose previous colposcopies had been described as normal. Data from additional postpartum examinations were available for 35 of 123 patients (28 percent), 23 of whom underwent cervical electrosurgical excision or conization and 5 of whom had a hysterectomy. Nine of the 35 had more advanced histopathological findings than was suspected at their initial postpartum colposcopy. Within 1 year of delivery, three more women were diagnosed with invasive cervical carcinoma. None of these women had a biopsy during pregnancy, and two had reportedly normal colposcopic findings when they were examined during pregnancy. Patient compliance with repeated examinations was a problem. Ninety-five women who underwent colposcopy before 35 weeksrsquo; gestation were scheduled to undergo a second colposcopy within 6 weeks, but only 24 returned for the examination.J Lower Genital Tract Dis 1999;3colon;225ndash;230
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