Pregnancy management of HPV infected patients is not recommended based on evidence-based medical evidence or consensus guidelines. In view o
Pregnancy management of HPV infected patients is not recommended based on evidence-based medical evidence or consensus guidelines. In view of the impact of HPV infection, HPV positive patients should be assessed if the patient is combined with other infections of the lower genital tract, cervical cancer screening, condyloma acuminatum, and then decide whether pregnancy.
Condyloma acuminatum before pregnancy
Acuteness wet wart sees with 20-29 years old young woman, pathological changes place is easy to be damaged when sexual intercourse place sees more. For those with condyloma acuminatum of the vulva, the vagina and cervix should be carefully examined. Acuteness wet wart should be active treatment of condyloma and then consider pregnancy. The treatment was only to remove the warts, improve symptoms and signs, local physical therapy or drug therapy.
Cervical lesions and pregnancy
The traditional theory that pregnancy will increase by estrogen and progesterone, cervical dilatation of immunosuppression and labor, can cause the spread of cancer cells, accelerate the development of cervical cancer. However, most studies suggest that pregnancy is not a risk factor for the progression of cervical lesions. Most of the lesions can be relieved or no progress in the postpartum, and the proportion of disease progression or reversal is not related to the mode of delivery.
Planned pregnancy for CINI patients
For patients with CINI, according to the guidelines for regular follow-up, if not found in the screening of higher levels of lesions, the screening period can be considered safe pregnancy.
CINII, III patients planning pregnancy
The probability of CINIII progression to cancer is very high, once diagnosed, the need for active treatment. Due to the consistency and repeatability of the CINII diagnostic results, the treatment is controversial. For patients with CINII, III, according to the guidelines for the initial treatment and regular follow-up after treatment, if not found in the screening of higher levels of lesions in the screening period can be considered safe pregnancy.
The risk of progression to cancer in women with CINI, II, and III levels was 13%, 30%, and 45%, respectively, and the risk of CIN was similar in women with pregnancy and non pregnancy. The outcome of CIN in pregnancy was significantly different from that reported in the literature: 25%-64% postpartum lesions were reversed, 34%-47% postpartum lesions persisted, and 3%-30% postpartum lesions progressed further. The incidence of cervical cancer during pregnancy is very low, only 0.45/1000 times of pregnancy; about 67% of patients with carcinoma in situ.
Screening for cervical cancer in pregnancy
Cervical cytology screening in pregnancy is safe, and the validity of screening is the same as that of non pregnancy screening. In view of the physiological changes of cervical cells during pregnancy, the effect of smear on the evaluation, in filling out the application form should be marked with a specimen of pregnancy, to assist in the identification of pathological doctors.
Cervical biopsy during pregnancy is relatively safe, and the risk of vaginal bleeding requiring further treatment is only 1%-3%, other complications such as preterm birth, chorioamnionitis, etc.. It is recommended that multiple biopsies can be performed at any gestational age. The sensitivity and specificity of cervical biopsy in the diagnosis of cervical lesions were 83.7% and 95.5%, respectively.
Conization of cervix
For pregnant women with suspected invasive cancer, the primary objective should be diagnosis rather than treatment. Bleeding in early pregnancy is the most common, premature delivery in late pregnancy increased significantly, it is recommended to be diagnosed between 14-20 weeks of pregnancy conization, can significantly reduce the risk of miscarriage and bleeding. 4 weeks before delivery, surgical removal should be avoided. Pregnancy endocervical curettage, will increase the risk of preterm delivery and premature rupture of membranes.
Recommended guidelines for screening for cervical cancer in pregnancy
Treatment of HPV infection related diseases in pregnancy
Although there is no clear HPV transmission route of mother to child transmission through the placenta, perinatal transmission, post natal transmission, there are rare cases of respiratory papillomatosis in infants and young children with HPV6 and HPV11 infection. Whether cesarean section can prevent the occurrence of respiratory papillomatosis in infants and young children is still not clear, therefore, it should not be used to prevent infantile respiratory papillomatosis.
Treatment of condyloma acuminatum in pregnancy
Giant condyloma acuminatum can blocking the birth canal, condyloma acuminatum in pregnancy vulnerability, vaginal delivery prone to bleeding. If pregnant condyloma vaginal delivery or pelvic outlet stenosis occurred bleeding, can be used in cesarean section. Pregnant women with condyloma acuminatum should be informed of the risk of recurrent respiratory papillomatosis in infants and young children.
The smaller lesions were treated with topical drugs, and 50% with three acetic acid. Disable the use of imiquimod, Mott, foot toxin, tea polyphenol ointment and interferon. For patients with large lesions, physical or surgical treatment is recommended. Prevention of infantile respiratory papillomatosis by cesarean section. If the outlet of wet wart of pregnant woman of acuteness wet wart is narrow or the haemorrhage that can produce through the vagina, can use caesarean section.
Treatment of CINI in pregnancy
CINI is a histological manifestation of HPV infection, and the rate of spontaneous regression is high. Especially young women, rarely progress to CINII+. According to the ASCCP2013 guidelines, women with CINI in pregnancy should be followed up for the first time.
Treatment of CINII and III in pregnancy
It is recommended only for women with suspected invasive lesions to perform a diagnostic resection. Treatment is not recommended unless proven invasive cancer is present. Women with histologically diagnosed CINII, CINIII, or CINII, or III, may have additional colposcopy and cytology at the time of non invasive or late pregnancy, and should not be more than 1 times every 12 weeks.
It is recommended that repeat biopsy should be performed only in the presence of lesions (or lesions) or in the presence of cytologic findings. Delay the re evaluation until at least 6 weeks postpartum. Re evaluation of cytology combined with colposcopy, and not less than 6 weeks postpartum.
Pregnancy after CIN treatment
At present, the commonly used methods for the treatment of cervical lesions include cryotherapy, electrocoagulation, laser treatment, laser conization, surgical conization and hysterectomy. Hysterectomy is only used in special circumstances, and the ASCCP and ACOG guidelines clearly point out that it should not be used as an initial treatment for CIN. Cryotherapy, electrocoagulation and laser therapy in the clinic, does not affect the pregnancy, but because no matter for tissue pathological examination, the misdiagnosis rate increased.
Conization of the cervix may be the pathological examination of the resected specimen, which is the main treatment strategy of CINII and III recommended by ASCCP. Commonly used conization of the cervix, including cervical circular resection (LEEP) and cold knife conization (CKC). With the popularization of cervical conization, its influence on the ability to conceive, the outcome of pregnancy and the mode of delivery has been paid more and more attention.