A cross-sectional study of cervical Papanicolaou smear changes in antenatal women
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20260893Keywords:
Pap smear, Opportunistic antenatal screening, Cervical cytology, Cervical cancerAbstract
Background: Cervical cancer is a preventable malignancy characterized by a prolonged preinvasive phase that allows early detection. Despite effective screening tools, coverage in India remains inadequate. This study evaluates cervical cytological findings in pregnant women and highlights antenatal care as a valuable opportunity for opportunistic cervical cancer screening, especially in settings where routine screening coverage is low.”
Methods: This hospital-based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, RIMS Imphal. A total of 354 pregnant women fulfilling the inclusion criteria underwent Papanicolaou (Pap) smear screening. Cytological findings were reported according to the Bethesda system. Associations between Pap smear findings and variables were analysed using chi-square test.
Results: Most participants were aged 21-30 years (72.4%) followed by 31-35 years (13%). Pap smear findings revealed negative for intraepithelial lesion or malignancy (NILM) in 76.8% of cases. Inflammatory smears were observed in 9.6%, bacterial vaginosis in 5.4%, unsatisfactory smears in 7.9%, and low-grade squamous intraepithelial lesion (LSIL) in 0.3%. A statistically significant association was observed between socio-economic status and Pap smear findings (p<0.01). No significant association was found with education level or age at marriage.
Conclusions: The findings highlight that antenatal care provides an important opportunity for opportunistic cervical cancer screening. Incorporating Pap smear screening into routine antenatal services may improve early detection of cervical abnormalities and strengthen cervical cancer prevention strategies in low-resource settings.
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References
Denny L. Cervical cancer: prevention and treatment. Discov Med. 2012;14:125-31.
Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis. Lancet Glob Health. 2020;8:e191-203. DOI: https://doi.org/10.1016/S2214-109X(19)30482-6
Accuracy of visual screening for cervical neoplasia: results from an IARC multicentre study in India and Africa. Int J Cancer. 2004;110:907-13. DOI: https://doi.org/10.1002/ijc.20190
World Health Organization. The global burden of disease: 2004 update. Geneva: World Health Organization; 2008. Available at: https://apps.who. int/iris/ handle/10665/43942. Accessed on 13 May 2025.
PR 223‑ Latest World Cancer Statistics Global Cancer Burden Rises to 14.1 million New Cases in 2012: Marked Increase in Breast Cancers must be Addressed. IARC. 2013.
Ginsburg O, Bray F, Coleman MP. The global burden of women’s cancers: a grand challenge in global health. Lancet. 2017;389:847-60. DOI: https://doi.org/10.1016/S0140-6736(16)31392-7
Stelzle D, Tanaka LF, Lee KK, Khalil AI, Baussano I, Shah AS, et al. Estimates of the global burden of cervical cancer associated with HIV. The lancet global health. 2021;9(2):e161-9. DOI: https://doi.org/10.1016/S2214-109X(20)30459-9
Gilbert TJ, Sugarman JR, Cobb N. Abnormal Papincolaou smears and colposcopy follow-up among American Indian and Alaskawomen in the Pacific North-West. J Am Fam Pract. 1995;8(3):183-8.
Kyrgiou M. Premalignant and Malignant Disease of the Cervix. Dewhurst’s Textbook of Obstetrics & Gynaecology. 2018;858. DOI: https://doi.org/10.1002/9781119211457.ch61
ICMR-NCDIR, Report on Monitoring Survey of Cancer Risk Factors and Health System Response in North East Region (NER) of India. 2022.
Drew PA, Wilkinson EJ. Conventional cytology. In: Apgar BS, Brotzman GL, Spitzer M, editors. Colposcopy principles and practice, An integrated textbook and Atlas. 2nd ed. Philadelphia PA: Saunders Elsevier. 2008;59-5.
Bergström R, Sparén P, Adami HO. Trends in the cancer of the cervix uteri. Br J Cancer. 1999;81:159-66. DOI: https://doi.org/10.1038/sj.bjc.6690666
Morice P, Uzan C, Gouy S, Versharaegen C, HaieMeder C. Gynaecological cancers in pregnancy. Lancet. 2012;379:558-69. DOI: https://doi.org/10.1016/S0140-6736(11)60829-5
Sankaranarayanan R, Ferlay J. Worldwide burden of gynecological cancer: The size of the problem. Best Pract Res Clin Obstet Gynaecol. 2006;20:207-25. DOI: https://doi.org/10.1016/j.bpobgyn.2005.10.007
Singh N. HPV and Cervical cancer - prospects for prevention through vaccination. Indian J Med Paediatr Oncol. 2005;26:20-3.
Senapathy JG, Umadevi P, Kannika PS. The present scenario of cervical cancer control and HPV epidemiology in India: An outline. Asian Pac J Cancer Prev. 2011;12:1107-15.
Dasari P. A grossly abnormal cervix: Evidence for using colposcopy in the absence of a squamous intraepithelial lesion by the conventional Papanicolau’s test. J Gynecologic Surg. 2011;27(1):5-8. DOI: https://doi.org/10.1089/gyn.2010.0035
International Agency for Research on Cancer Global Cancer Observatory. Available at: http:// gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf. Accessed on 15 August 2025.
Centers for Disease Control and Prevention. Global Cancer Statistics. Available at: http://www.cdc.gov/cancer/international/statistics.htm. Accessed on 13 May 2025.
Gonçalves CV, Duarte G, Costa JSD da, Marcolin AC, Bianchi MS, Dias D, et. al. Diagnosis and treatment of cervical cancer during pregnancy. Sao Paulo Med J. 2009;127:359-65. DOI: https://doi.org/10.1590/S1516-31802009000600008
Shaw PA. The History of Cervical Screening I: The PAP. Test. J SOJC. 2000;22(2):110-4. DOI: https://doi.org/10.1016/S0849-5831(16)31416-1
WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Summary report on HPV and cervical cancer statistics in India. 2007. Available at: https://hpvcentre.net/link_media/HPV Report2007.pdf Accessed on 3 December 2025.
Mishra V, Dorairajan G, Neelaiah S, Chinnakali P. Prevalence of abnormal PAP smear during pregnancy in a teaching hospital in South India. Int J Reproduct Contracept Obstet Gynecol. 2015;4(5):1296-9. DOI: https://doi.org/10.18203/2320-1770.ijrcog20150699
Agarwal P, Gupta R, Kakkar M, Mishra T, Agrawal D, Dahiya S. Comparison of Liquid-based Cytology and Conventional Papnicolaou Smear as a Screening Tool in High-risk Females. J S Asian Federat Obstetr Gynaecol. 2018;11(3):156-60. DOI: https://doi.org/10.5005/jp-journals-10006-1673
Ngaojaruwong N, Vuthiwong C, Punpuckdeckoon P, Thongsorn N. Prevalence of abnormal Papanicolaou smear in pregnant women at Phramongkutklao Hospital. Thai J Obstet Gynaecol. 2008;16:179-85.
Manikkam B. Screening for cervical cancer during pregnancy. Int J Community Med Public Health. 2016;3(9):2493-8. DOI: https://doi.org/10.18203/2394-6040.ijcmph20163059
Himabindu P, Kanwal A, Vasudha. PAP Smear in Antenatal Women-Routine Screening in Low Resource Settings. IOSR J Dental Med Sci. 2015;14(4):4-5.
Ethirajan S, Srinidhi R, Jayashree K. PAP smear in antepartum women: an opportunity to screen and create awareness. Int J Reproduct Contracept Obstet Gynecol. 2018;7:4093-6. DOI: https://doi.org/10.18203/2320-1770.ijrcog20184134
Khaengkhor P, Mairaing K, Suwannarurk K, Thaweekul Y, Poomtavorn Y, Pattaraarchachai J, et al. Prevalence of abnormal cervical cytology by liquid-based cytology in the antenatal care clinic, Thammasat University Hospital. J Med Associat Thailand. 2011;94(2):152.
Priya SS, Shankar R. PAP smear in pregnancy: a hospital-based study. Int J Reproduct Contracept Obstet Gynecol. 2018;7(12):4924-9. DOI: https://doi.org/10.18203/2320-1770.ijrcog20184941
Bhutia K, Puri M, Gami N, Aggarwal K, Trivedi SS. Persistent inflammation on PAP smear: Does it warrant evaluation? Indian J Cancer. 2011;48(2):220-2. DOI: https://doi.org/10.4103/0019-509X.82901
Barouti E, Farzaneh F, Sene A. The pathogenic microorganism in papanicolaou vaginal smears and correlation with inflammation. J Family Reproduct Health. 2013;7(1):23-7.
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