Natural History of Squamous Intraepithelial Lesions in Pregnancy and Mode of Delivery

Background: Numerous studies have addressed the impact of mode of delivery on the natural history of squamous intraepithelial lesions (SIL) in pregnant women. However, the literature is still contradictory. Patients and Methods: In the course of a retrospective analysis, data of 63 pregnant women with abnormal cervical smears who were referred to our Outpatient Department for pre-invasive lesions of the cervix were analyzed. The study was conducted at the General Hospital in Vienna, Austria, between 2010 and 2015. Data collection included demographics, delivery route and diagnostic results of cervical lesions by cytology, colposcopy, human papilloma virus (HPV) testing, histological report of punch biopsy and, if applicable, cone biopsy. Results: Among 63 women who met the inclusion criteria, 40 (63%) delivered vaginally and 23 (37%) underwent caesarean section. Postpartum regression of cervical dysplasia was documented in 15 women delivering vaginally and in 10 who had a caesarean section (p=0.641). Among those women who delivered vaginally, three had progression and in 22 women the lesions persisted postpartum. In the group of women with caesarean section, one had progression and the lesions of 12 women persisted after delivery. No woman had progression to invasive disease. Conclusion: The mode of delivery does not significantly influence the natural history of cervical dysplastic lesions in pregnant women. The numbers of spontaneous regressions to normal cervical cytology during pregnancy were similar in both groups.

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