SEVERE CERVICAL INTRAEPITHELIAL NEOPLASIAS (CIN II-III/CARCINOMA IN SITU) AND MICROCARCINOMA OF THE CERVIX UTERI IN PREGNANT WOMEN

Objective. To compare the clinical, morphological, and virologic characteristics of severe epithelial lesions and microcarcinomas of the cervix uteri in pregnant and nonpregnant women, to study disease and pregnancy outcomes, and to assess prognosis. Subjects and methods. Thirty-six pregnant women with cervical intraepithelial neoplasias (CIN), including 7 patients with CIN II, 23 with CIN III/carcinoma in situ (CIS), and 6 with microinvasive carcinoma of the cervix uteri, and 248 nonpregnant women with the same diagnoses. The clinical course of the disease was comparatively analyzed on the basis of cytological, virologic, colposcopic, and histologic findings and the results of treatment and follow-up. Results. All the patients were found to have varying epithelial lesions concurrent with colposcopic changes; viral load was significantly higher in pregnant women. Progressive gravid ectopy favored the hyperdiagnosis of a presumptive grade of CIN. The results of postpartum histological examination agreed with those of pregnancy biopsy in 44.4%; the degree of lesions was less in 22.2% and higher in 33.4%. Thirty-three of the 36 women successfully carried pregnancy. The mean follow-up was 26 months. All the patients are alive and have no recurrence of CIN and cancer of the cervix uteri. The infants are developing normally. Conclusion. Full-term pregnancy does not worsen disease prognosis in CIN II-III, including CIS. Targeted biopsies under colposcopic guidance are safe and advisable to define the degree of a lesion, they are indicated for suspected cases of severe CIN and invasion and are, however, also acceptable in other cases. If microinvasion is found, treatment may be delayed until after cesarean section.

CIN II—III, cervical intraepithelial neoplasia II-III, papillomavirus infection, carcinoma in situ of the cervix uteri, microcarcinoma of the cervix uteri, pregnancy