Prevalence of abnormal Pap smear during pregnancy in a teaching hospital in South India

Varsha Mishra, Gowri Dorairajan, Siddaraju Neelaiah, Palnivel Chinnakali


Background: The prevalence of cancer cervix is very high in our country. Women in our country typically present late when the disease is advanced. Screening during pregnancy gives an opportunity to pick up at pre-invasive/early stage as women come voluntarily seeking health care to hospitals. Abnormal cervical cytology is also associated with increased risk of adverse pregnancy outcome. This study was undertaken to determine the prevalence of abnormal Pap smear among pregnant women.

Methods: This cross sectional study was carried out in a teaching institution among pregnant women using conventional cytology (with Ayer’s spatula) reported by Bethesda system after obtaining informed consent. The study was approved by institute ethics committee.

Results: Among the 316 women studied the mean (SD) age at marriage was 22 (3) years. The mean period of gestation was 30 weeks. Only one participant (0.3%) reported high risk behaviour. The speculum examination was found to be normal in 99.7% women. There was one abnormal Pap smear report. Specific infection with Candida was reported in 14.6%; in none of these the speculum examination showed a characteristic discharge of candidiasis. Further a significantly higher prevalence of Candida infection was found in rural compared to urban population (Chi square 3.7, p=0.046).

Conclusions: The prevalence of abnormal Pap smear is particularly low at 0.3% in our study group. However the prevalence of asymptomatic Candida infection which was missed on speculum exam because of lack of the characteristic discharge was high at 14.6%. Thus the authors recommend routine prenatal microbiological examination to detect candida infection.


Abnormal Pap, Intraepithelial neoplasia, Screening, Pregnancy, Preterm labour

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National Centre for Disease Informatics Research. National Cancer Registry Programme, ICMR Three Year Report of Population Based Registries, 2009-2011. Bangalore, India: NCDIR-NCRP (ICMR); 2014.

Castellsagne X, de Sanjose S, Aguado T, Louie KS, Bruni L, Muñoz J, et al. HPV and cervical cancer in the world. 2007 report. WHO/ICO information centre on HPV and cervical cancer. Vaccine. 2007;25(Suppl 3):C1-C26.

He Y, Wu YM, Wang T, Song F, Wang Y, Zhu L. Perinatal outcomes of pregnant women with cervical intraepithelial neoplasia. Arch Gynecol Obstet. 2013;288:1237-42.

Hong JN, Berggren EK, Campbell SL, Smith JS, Rahangdale L. Abnormal cervical cancer screening in pregnancy and preterm delivery. Paediatr Perinat Epidemiol. 2014;28:297-301.

Aguin TJ, Sobel JD. Vulvovaginal candidiasis in pregnancy. Curr Infect Dis Rep. 2015;17:462.

Roberts CL, Algert CS, Rickard KL, Morris JM. Treatment of vaginal candidiasis for the prevention of preterm birth: a systematic review and meta-analysis. Syst Rev. 2015;4:31.

Farr A, Kiss H, Hagmann M, Marschalek J, Husslein P, Petricevic L. Routine use of an antenatal infection screen-and-treat program to prevent preterm birth: long-term experience at a tertiary referral center. Birth. 2015;42:173-80.

Leli C, Mencacci A, Meucci M, Bietolini C, Vitali M, Farinelli S, et al. Association of pregnancy and Candida vaginal colonization in women with or without symptoms of vulvovaginitis. Minerva Ginecol. 2013;65:303-9.

Shrestha S, Tuladhar NR, Basnyat S, Acharya GP, Shrestha P, Kumar P. Prevalence of vaginitis among pregnant women attending Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, Nepal. Nepal Med Coll J. 2011;13:293-6.

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 Assoc Thai. 2011;94:152-8.

McIntyre-Seltman K, Lesnock JL. Cervical cancer screening in pregnancy. Obstet Gynecol Clin North Am. 2008;35:645-58.

Seda J, Avellanet Y, Roca FJ, Hernández E, Umpierre SA, Romaguera J. Risk factors for abnormal cervical cytology in pregnant women attending the high-risk obstetrics clinic at the University Hospital in San Juan, Puerto Rico. P R Health Sci J. 2011;30:14-7.

Khanuja E, Ghosh UK, Garg P, Tomar G, Madan M, Bansal R. A study of cervical intraepithelial neoplasia in pregnancy. J Obstet Gynaecol India. 2014;64:193-6.