A PEER-REVIEWED JOURNAL OF RESEARCH AND CLINICAL MEDICINEISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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Disorders of the Cervix and Characteristics of Colposcopy in Pregnant Women

DOI:10.31550/1727-2378-2020-19-8-32-39
For citation: Bebneva T.N., Dikke G.B. Disorders of the Cervix and Characteristics of Colposcopy in Pregnant Women. Doctor.Ru. 2020; 19(8): 32–39. (in Russian). DOI: 10.31550/1727-2378-2020-19-8-32-39

Study Objective: To determine the frequency of disorders of the cervix and identify characteristics of colposcopy specific to pregnant women infected with the human papillomavirus (HPV).

Study Design: This was an open-label, non-interventional, comparative, cohort clinical study.

Materials and Methods: Three hundred and thirty pregnant women participated in the study. They were divided into four groups: Group I (n = 73) was made up of women without any disorders of the cervix and with a negative test for human papillomavirus (HPV); Group II (n = 75) consisted of women with disorders of the cervix who did not have HPV; Group III (n = 96) comprised those who did not have disorders of the cervix, but had HPV; and Group IV (n = 86) consisted of patients with disorders of the cervix and HPV. Examinations performed included HPV testing with serotyping, cervical cytology (Pap smear), and colposcopy.

Study Results: HPV was detected in 55.2% of the patients (182/330), 44.5% of whom (81/182) had types 16/18 HPV. The prevalence of grades I and II disorders of the cervix (mild and moderate) in women who had HPV as well as disorders of the cervix was 17.5% (15/86) according to colposcopy data and 9.3% (8/86) detected by cytology (р = 0.06). The total frequency of these disorders, irrespective of HPV status, was 9.3% (15/161) and 5.6% (9/161), respectively (р = 0.29). Interpretation of the colposcopy data in pregnant women was difficult in some cases due to changes in the cervix, which explains the 3.7% discrepancy between colposcopy and cytology in detecting disorders of the cervix.

Conclusion: HPV screening may be done first in pregnant women, followed by cytology in HPV-positive patients. Colposcopy may be reserved for women with high-grade squamous intraepithelial lesions to exclude invasive cancer.

Contributions: Dr. T.N. Bebneva developed the concept and design of the study, collected clinical data and created an electronic database of results, checked critically important content, and approved the final version of the manuscript before submission for publication. Dr. G.B. Dikke fine-tuned the design of the study and the electronic database of results, analyzed and interpreted the results of statistical processing of clinical data, drafted the paper and edited it after review, and approved the final version of the manuscript before submission for publication.

Conflict of interest: The authors declare that they do not have any conflict of interests.

T.N. Bebneva (Corresponding author) — Peoples’ Friendship University of Russia (a Federal Government Autonomous Educational Institution of Higher Education); 21 Miklouho-Maclay St., Bldg. 3, Moscow, Russian Federation 117198. National Medical Research Center for Endocrinology (a Federal Government-funded Institution), Russian Federation Ministry of Health; 11 Dmitry Ulyanov St., Moscow, Russian Federation 115478. https://orcid.org/0000-0003-1095-2008. E-mail: bebn@mail.ru

G.B. Dikke — F.I. Inozemtsev Academy of Medical Education (a Private Educational Institution of Advanced Professional Education); 22M Moskovsky Prospect, St. Petersburg, Russian Federation 190013. https://orcid.org/0000-0001-9524-8962. E-mail: galadikke@yandex.ru

Доктор.ру

Table 1

Overall clinical characteristics of study participants (n = 330), n (%)

t5_1.jpg

* Differences from Group I were statistically significant (р<0.05, using the χ2 test).

** Differences from Group II were statistically significant (р<0.05, using the χ2 test).

*** Differences from Group III were statistically significant (р<0.05, using the χ2 test).

Table 2

Frequency and types of disorders of the cervix in the pregnant women as evidenced by colposcopy (n = 330), n (%)

t5_2.jpg

Notes:

1. Here and in figures: TZ = transformation zone.

2. * Differences from Groups I-III were statistically significant (using the χ2 test): (*) — < 0.05; (**) — р < 0.001; (***) — р < 0.0001.

Fig. 1. Patient N., age 32. Repeat pregnancy, 14 weeks. Adequate colposcopy, type 2 TZ. A. A large amount of mucus covers the cervix. Б. The squamocolumnar junction is well visualized because of eversion of the cervical canal. All photos in the paper courtesy of the authors

r5_1.jpg 

Fig. 2. A. Patient N., age 32. Repeat pregnancy, 21 weeks. Adequate colposcopy, type 3 TZ. The cervix is cyanotic. A large zone of the metaplastic epithelium is well visualized after acetowhitening (normal). Б. Patient R., age 25, not pregnant. Adequate colposcopy, type 1 TZ (in both cases cytology revealed no abnormalities)

r5_2.jpg 

Fig 3. Patient Sh., age 29. First pregnancy, 21 weeks. Adequate colposcopy; the squamocolumnar junction is not fully visualized, type 3 TZ. A. A marked reaction of the cervical metaplastic epithelium to acetowhitening mimics low-grade squamous intraepithelial lesions. Б. Schiller's test shows small iodine non-uptake areas (cytology revealed no abnormalities)

r5_3.jpg 

Fig 4. А. Patient S., age 27. Repeat pregnancy, 18 weeks. Adequate colposcopy, type 3 TZ (the squamocolumnar junction is not fully visualized). A marked reaction of the cervical metaplastic epithelium to acetowhitening mimics high-grade squamous intraepithelial lesions (HSIL) (cytology revealed no abnormalities). Б. Patient M., age 35. Repeat pregnancy, 18-19 weeks. Adequate colposcopy, type 1 TZ. A slight reaction to acetowhitening mimics low-grade squamous intraepithelial lesions (cytology revealed HSIL)

r5_4.jpg 

Fig 5. Patient A., age 27. First pregnancy, 16 weeks. Adequate colposcopy, type 1 TZ. A and Б. Deciduosis of the cervix (cytology revealed no abnormalities)

r5_5.jpg 

Fig 6. A. Patient N., age 26. Repeat pregnancy, 14-15 weeks. Adequate colposcopy, type 1 TZ. Б. Patient R., age 27, not pregnant. Adequate colposcopy, type 1 TZ. Thin acetowhite epithelium with irregular, geographical border (grade I, mild lesion) is seen in both cases after acetowhitening (cytology revealed low-grade squamous intraepithelial lesions)

r5_6.jpg 

Fig 7. A. Patient N., age 26. Repeat pregnancy, 17-18 weeks. Inadequate colposcopy due to spotting, type 2 TZ. Б. Patient S., age 29, not pregnant. Adequate colposcopy, type 2 TZ; however, the squamocolumnar junction is not fully visualized. Rough acetowhite epithelium (grade II lesion) is seen in both cases after acetowhitening (cytology revealed high-grade squamous intraepithelial lesions)

r5_7.jpg 

Fig. 8. Patient P., age 29. Repeat pregnancy, 11-12 weeks. Adequate colposcopy, type 2 TZ. A. Rough acetowhite epithelium is seen in the squamocolumnar junction region after acetowhitening (grade II lesion). Б. Schiller's test shows iodine non-uptake by the epithelium in the squamocolumnar junction region (cytology revealed high-grade squamous intraepithelial lesions)

r5_8.jpg 

Fig 9. Patient S., age 26. First pregnancy, 14-15 weeks. Adequate colposcopy, type 1 TZ; the squamocolumnar junction is fully visualized. Grade I lesion. Inflammation. A. Areas of acetowhite epithelium with poorly defined borders are seen after acetowhitening. Б. Schiller's test shows slight nonuniform staining

r5_9.jpg 

Fig 10. Patient M., age 36. Repeat pregnancy, 17-18 weeks. Adequate colposcopy, the squamocolumnar junction is fully visualized, type 1 TZ. Inflammation (columnar epithelium is edematous, mild bleeding to the touch). A. Mild reaction to acetowhitening. Б. Schiller's test shows slight nonuniform staining

r5_10.jpg 

Fig 11. Patient N., age 25. First pregnancy, 18 weeks. Adequate colposcopy, type 2 TZ, the squamocolumnar junction is not fully visualized. Grade II lesion. Inflammation (areas with necrotic epithelium). A. Areas of acetowhite epithelium with well-defined borders are seen after acetowhitening. Б. Schiller's test shows nonuniform staining (cytology revealed inflammation)

r5_11.jpg 

Received: 05.10.2020

Accepted: 15.10.2020


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