Pap smear in pregnancy, everything you need to know

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Philippe Gloaguen
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Protecting yourself from the Papilloma Virus through the Pap Test is the best way to do prevention through screening to detect cervical cancer. The Pap Test is an indispensable weapon and, even if it should not be repeated every year but on a regular basis depending on the age groups and risk factors, it is not a test that can be left on the back burner. But how to behave with the Pap test in pregnancy? What are the guidelines for pregnant women and what to do if the test gives a positive result? Here are the answers to the main questions





In this article

  • Pap smear in pregnancy, guidelines
  • Pap test during pregnancy, up to what week can it be done?
  • Positive Pap smear in pregnancy

Pap smear in pregnancy, guidelines

There is no contraindication to performing the Pap test during pregnancy, on the contrary, the screening exam is absolutely recommended by experts. According to the guidelines of the El Paese Screening Group for Cervicocarcinoma (GISCI), in fact, "about 1-3% of women who receive a diagnosis of cervical cancer are in pregnancy or postpartum, with an estimated incidence between 0,8, 1,5 and 10.000 cases per 2 births and about 10.000 per XNUMX pregnancies ". Unfortunately, the GISCI guidelines continue, "cervical cancer represents, together with breast cancer and melanoma, one of the most frequently diagnosed cancers during pregnancy".



In this sense, the Pap Test is an excellent way to activate a virtuous analysis, even during pregnancy: it does not harm the baby or even the mother, indeed, for her it is really an ally.

How is the Pap test done during pregnancy?

Exactly the same way as when you are not pregnant. As reported by the AIRC, "the examination is carried out in the same way as a gynecological examination, during which the speculum is applied, a special instrument that slightly dilates the vaginal opening in order to facilitate the sampling. The operator inserts then delicately a special spatula and a cotton swab which are used to collect small amounts of mucus respectively from the cervix and from the cervical canal. On this sample, in the laboratory, a cytological examination will be carried out, on the cells exfoliated by the lining tissue of the cervix, examining them with appropriate staining methods and a thorough computerized examination ".

The Pap Test during pregnancy is therefore usually carried out a double sampling of cervical mucus for the cytological examination of the uterine cervix: one exocervical with the Ayre spatula, the other endocervical using a brush which can also be carried out during pregnancy without any contraindications.

GISCE confirms that there are no risks to pregnancy when Pap smear is done, although some endocervical sampling devices are avoided after the XNUMXth week of pregnancy. "Alternative tools are then used, for
which has not been reported as a contraindication and which screening programs can adopt to allow the surveillance of pregnant women ".


Who can get the Pap test

All women, for preventive purposes. Pregnant women can do it virgin women (the doctor and midwife performing the test should be informed so that they can use adequate tools to dilate the opening of the vagina) and menopausal women, at least up to 65 years of age.


Pap smear in pregnancy, until when can it be done?

GISCI guidelines on Pap smears in pregnancy confirm that it is possible to do the test "in first trimester of pregnancy, within the 6th week of gestation and 2022 days. "This rule applies especially if the test has not been performed in the previous three years, the results of which are still valid. The HPV test was introduced in 2022 as a replacement for the Pap test in National Prevention Plan 2022-2022 and validated by GISCI in XNUMX: it is an exam that looks for the papilloma virus, the person in charge of cervical cancer.

For non-pregnant women, according to the new guidelines, these rules apply:

  • Pap smears must be done every three years by women between 21 and 29, since infections are more frequent in this age group
  • The HPV test should instead be done every five years in the age group between 30 and 65 years to check for the presence of the Papilloma Virus

The difference between the two tests lies precisely in this: the HPV test looks for the virus itself and does it very effectively (for this reason it can be repeated every 5 years), while the Pap Test, while being equally effective, looks for the preneoplastic and neoplastic lesions of the uterine cervix which often causes. The first way is faster and cheaper than the health system, although the Pap test still remains a second level screening tool. They are carried out in the same way but the analytical methods therefore change and the same rules apply to pregnant women.

Positive pregnancy pap smear

If the Pap test indicates the presence of lesions or the HPV test has detected the papilloma virus in a pregnant woman, biogna rest assured: no risks for the baby have been demonstrated. However, it is necessary to keep the lesions under control and to postpone the therapy until after the birth. There are no problems with breastfeeding either, once the baby is born and it does not involve fetal malformations or other problems for the fetus.

In non-pregnant women, with a positive HPV test, a Pap Test is performed first, to verify that there have been no changes or lesions on the cervix; if this second test is also successful, we will proceed with the Via/ Villi

A positive HPV test with a negative Pap Test instead implies the repetition of the first screening test after one year to check for the presence or absence of the infection, which usually disappears spontaneously in this period of time.

It goes without saying that this in-depth investigation for pregnant women with positive HPV or positive Pap tests will need to be done immediately after giving birth.

What to do if genital warts appear

Condylomas are small lesions, also called "cockscombs", which can appear on the male or female genitals and cause burning or itching. They are not dangerous but, if they occur during pregnancy, the risk (possible but not obligatory) is that of having to do a caesarean section instead of a natural birth at birth, although they can be easily treated with local anesthesia before giving birth vaginally. 

Sources for the article: GISCI, Indications for the collection of cervical cancer screening; Ministry of Health, National Prevention Plan 2022-2022

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