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Management of low and high grade squamous intraepithelial lesions during pregnancy

Despite significant advances regarding screening and treatment of cervical dysplasia, cervical cancer in fertile age is becoming more and more common in the last two decades1. Cervical cancer screening ideally detects preinvasive lesions that can be eradicated or early stage cervical cancer that can be successfully treated. Cervical cancer screening was previously limited to cervical cytology. However, during the past decade, High-Risk Human Papillomavirus (HR HPV) testing has also become an important screening tool2. The incidence of cervical cancer in pregnancy is estimated to be 1-10/10000 pregnancies3, while abnormal cervical cytology is at least as high as reported for nonpregnant women4. Among dysplasia cases diagnosed during pregnancy, 10%-70% regress and sometimes even disappear postpartum, while persistence in the severity of cervical neoplasia is reported in 25%-47% and progression occurs in 3%-30%. However, adequate follow-up and definitive management in the postpartum period is important3. There are various strategies in different countries whether to perform cervical screening in pregnancy. Differences depend on variables such as local incidence of cervical cancer, presence of organized screening in each country, population coverage by screening, social awareness of the disease, etc. However, there are no medical reasons why screening should not be performed during pregnancy. The objective of this review is to assess proper management of Squamous Intraepithelial Lesions (SIL) during pregnancy. Screening tolls Cervical cytology Cervical cytology became the standard screening test for cervical cancer and premalignant cervical lesions with the introduction of the Papanicolaou (Pap) smear in 19415. Liquid-based, thin-layer preparation of cervical cytology specimens was a subsequent modification of this technique. Both test modalities detect most cases of cervical neoplasia during the typically prolonged premalignant or early occult invasive phases, when treatment outcomes are optimal. Both of them are considered equally acceptable for screening6. Terminology for reporting cervical cytology was standardized by the Bethesda System in 19887. This system has been revised several times, and the current system was deHJOG An Obstetrics and Gynecology International Journal