Title:

Diagnostic and therapeutic management of abnormal cervical smear in pregnant women

Author:

Kolawa, Wojciech

Subject:

CIN ; cervical cancer ; pregnancy ; colposcopy ; cytology

Abstract:

We analyzed 128 pregnant women with cytological epithelial cell abnormalities. Material was divided into two groups. In group A traditional colposcopy was used, in group B digital colposcopy was implemented. The aim of the study was to: 1) estimate the value of cytology and colposcopy in diagnostic process of CIN and invasive cervical cancer in pregnancy. 2) determine the value of digital colposcopy in diagnostics and monitoring of CIN and invasive cervical cancer in pregnancy comparing to control group evaluated by traditional colposcopy. 3) analysis of behavior of CIN and early invasive cancer in pregnancy and puerperium. Concordance of cytology and colposcopy with biopsy histology result was evaluated. The latter was compared with histology of cone or hysterectomy specimen as well. The following conclusions has been created on the basis of the obtained results: 1) despite diagnostic difficulties resulting from pregnancy related changes of epithelium and stroma, colposcopy and cytology effectively enable diagnosis and monitoring of cervical intraepithelial neoplasia and effectively enable diagnosis of early invasive cervical cancer, 2) colposcopy seems to be more efficient method than cytology in detecting CIN and early cervical cancer, and especially in monitoring those lesions. The special value is ascribed to digital colposcopy that enables diminution of the percentage of repeated biopsies, 3) in cases of suspected early invasive cancer wedge biopsy enables more precise histological evaluation than traditional biopsy and does not have negative influence on pregnancy, 4)pregnancy do not accelerate progression of preinvasive cervical lesions and vaginal delivery may be recommended if other contraindications are missing, 5) planned delay of treatment in early invasive cancer until fetal maturity is achieved do not worsens prognosis. Similarly planned delay of treatment in invasive caner stage IB from 4 – 7 weeks and in stage IIA 2 weeks to achieve fetal ability to survive do not influence progression of the disease, 6) present diagnostic methods detecting CIN and early invasive cancer that highly correlate with definitive histological results together with ability to keep alive infants born after 25 week of gestation enable in high percentage good prognosis both for the mother and the fetus.

Level of degree:

2 - studia doktoranckie

Degree discipline:

ginekologia ; onkologia

Degree grantor:

Wydział Lekarski

Promoter:

Antoni Basta

Date:

2008

Date issued:

2007

Type:

Praca doktorska

Format:

application/pdf

Call number:

ZB-107536

ControlNumberVIRTUA:

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Access rights:

nieograniczony

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego - Collegium Medicum

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