DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172303

Cervical cancer screening in pregnancy at the maternity clinics of Nabil Choucair health center and the Institute of Social Hygiene of Dakar, Senegal: a study on 67 cases

Omar Gassama, Mouhamadou Mansour Niang, Marie Edouard Faye Dieme, Ousmane Thiam, Mamour Gueye, Mame Diarra, Ndiaye Gueye, Philippe Marc Moreira, Djibril Diallo, Mamadou Lamine Cisse, Cheickh Tidiane Cisse, Jean Charles Moreau

Abstract


Background: This study aims were to develop the epidemiological profile of patients who received Pap smears during pregnancy, to describe aspects of cytological smears performed in pregnant women and to describe the therapeutic management in case of anomalies in the cervical smear during pregnancy.

Methods: This was a prospective, descriptive and analytical study conducted from January 15, 2015 to June 31, 2015 at maternity of Nabil Choucair Health Centre and the Institute of Social Hygiene in Dakar. The Pap smear was performed in all patients who had given their consent to the experience. The parameters studied concerned socio-demographic aspects, gynecological and obstetric background, gestational age at the time of collection, cervico-vaginal smear results, diagnostic and therapeutic management of cytological and histological abnormalities. The data collected on a survey sheet prepared for this purpose were entered and analyzed through the version 3.5.3 of Epi info software.

Results: During the study period, 67 pregnant women had received a Pap smear. The epidemiological profile of our patient was a paucipare gestity with an average of 3 with extremes ranging from 1 to 7, an average parity of 2.4 with extremes ranging from 1 to 7. The mean age of pregnancy was 15.4 weeks of amenorrhea (range of 6 and 32 weeks). Only 5 patients (7.4%) had already received a cervical-vaginal swab before the study. The smear was normal in 88.7% of the cases but got abnormalities in 11.3% of the cases. The abnormalities were mainly found in squamous cells and were divided into low-grade lesions (57.1%) and skew-cell abnormalities whose meaning was undetermined (42.1%). Colposcopy was performed in 8 patients. Colposcopy was normal and satisfactory in 4 patients (50%) and identified as atypical grade 1 transformation in 2 patients (25%) and an atypical grade 2 transformation in 2 patients (25%). From a therapeutic point of view, diathermic loop conduction associated with strapping was performed in one patient (12.5%) for severe dysplasia. In postpartum, all dysplastic cervical lesions diagnosed during pregnancy had declined.

Conclusions: In the context of our study, where there is no organized screening policy for cervical cancer, antenatal clinics are an excellent screening opportunity to seize.


Keywords


Cervical cancer, Colposcopy, Conization, Pap smear, Pregnancy

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References


International Agency for Research on Cancer, World Health Organization. Latest world statistics, global cancer burden rises to 14.1 million new cases in 2012. Marked increase in breast cancer must be addressed Press Release N° 223 December 2013.

World Health Organization. Essencial practices Guide. Fighting cervical cancer World Health Organization; 2007:300.

ICO (Institut Català Oncologia) Information center on HPV and cancer. Senegal: Human Papillomavirus and related cancers fact sheet, Dec 15, 2014.

Zoundi-Ouango O, Morcel K, Classe JM, Burtin F, Audrain O, Levêque J. Lésions cervicales utérines pendant la grossesse: diagnostic et prise en charge. Journal de gynécologie obstétrique et biologie de la reproduction. 2006 May 1;35(3):227-36.

Selleret L, Mathevet P. Diagnostic Et Prise En Charge Des Lésions Précancéreuses Du Col Utérin Pendant La Grossesse. Gynécol Obstet Biol Repro. 2008;37SL:S131-8.

Haute Autorité de Santé de la France Dépistage Et Prévention Du Cancer Du Col De L'utérus: Actualisation Du Référentiel De Pratiques De L'examen Périodique De Santé (EPS); 2013.

Monsonego J. Infections à human papillomavirus: Etats des connaissances, pratiques et prévention vaccinale. Springer, Paris; 2006:264.

Agence Nationale De La Statistique Et De La Démographie (Sénégal). Enquête Démographique et de Santé à Indicateurs multiples au Sénégal (EDS-MICS), 2010-2011. Calverton, Maryland, USA: ANDS et ICF International.

Mc Donnell JM, Mylotte MJ. Colposcopy in pregnancy: a 12-year review. Br J Obstet Gynecol. 1981;88:914-20.

Kaplan. Prognosis and recurrence risk for patients with cervical squamous intraepithelial lesions diagnosed during pregnancy. Cancer. 2004;102:2228-32.

Baldauff JJ. Colposcopy and directed biopsy during pregnancy: a cohort study. Eur J Obstet Gynecol Reprod Biol. 1995;62:31-6.

Marchetta J, Deschamps P. La colposcopy: techniques et diagnostics. Ed. Elsevier Masson Belgique; 2008:196.

Muszinsky C, Gondry J. Cervical intraepithelial neoplasia and invasive cervical cancer: some specificities to be known. General Cancer Journals, Gynecology and Obstetrics Realities. 2013;127.

Morimura Y. Cervical cytology during pregnancy: comparison with no-pregnant woman and management of pregnant woman with abnormal cytology Fukishima J Med Sci. 2002;48:27-37.

Benedet JL. Colposcopic evaluation of abnormal papanicolaov smears in pregnancy. Am J Obstet Gynecol. 1987;157:932-7.

Michael CW. Pregnancy-related changes: a retrospective review of 278 cervical smears. Diagn cytopathol. 1997;17:99-107.

National Institute of Public Health, Quebec. Guidelines for Cervical Cancer Screening in Quebec; 2016. available at https // www.inspq.qc.ca / pdf ... / 1279_LignesDirectDepistCancerCo.

Calsteren V. Cervical néoplasia during pregnancy: diagnosis, management and prognosis. Best Pract Research Obstet Gynaecol. 2005;19:611-30.