CIN

Question 1

What’s the CIN management in pregnancy?

Answer 1

During pregnancy
Due for routine recall > defer till after delivery.
Due for colposcopy [or TOC cytology]:
After cytology showing high grade dyskario-*> Do in late 1st or early 2nd
TM.
After cytology showing low grade dyskario & triaged HPV +ve > Defer till
after delivery.
As follow up after untreated CIN1 or treated CIN 2/3 > Defer till after
deliverv.
As follow up after treated CIN 2/3 with +ve margins > Don’t delay.
As follow up after previous abnormal colposcopy > Don’t delay.
As follow up after treated GIN > Don’t delay.
If repeat cytology is due but missed/defaulted, & the woman came while
pregnant > cytology or colposcopy can be considered.
The primary aim of colposcopic examination of a pregnant woman is to
exclude invasive disease and to defer biopsy or treatment until the
woman has delivered. Women seen in early pregnancy may require a
further assessment in the late second trimester.
Colposcopy is already done on the pregnant woman. Action?
If CIN1 or less is suspected > repeat the examination three months following
delivery.
If CIN2/CIN3 is suspected > excision not reliable, so repeat colposcopy:
At the end of the second trimester if done in 1s or 2nd TM.
Three months following delivery if done after the end of 2nd TM.
If invasive disease is suspected > Biopsy [cone, wedge or loop. NOT punch]. ~
25% risk of hemorrhage so needs appropriate facilities.
Use of contraceptives:
An abnormal screening result should not influence the choice of contraception
[despite the fact that RR for developing CIN may be increased].
It is not necessary to remove an IUD to perform local treatment.
RCTs NOT metanalysis] showed that condom use may promote HPV clearance
and CIN1 regression in conservative management, but this depends on their
consistent use for at least three months.