Prevalence and associated risk factors of abnormal pap smear in pregnant women

Authors

  • Neha Mohindroo Department of Obstetrics and Gynecology, Kamla Nehru Hospital for Mother and Child IGMCH Shimla, Himachal Pradesh, India
  • Anoop Sharma Department of Obstetrics and Gynecology, Kamla Nehru Hospital for Mother and Child IGMCH Shimla, Himachal Pradesh, India
  • Santosh Minhas Department of Obstetrics and Gynecology, MM Medical College and Hospital, Kumarhatti-Solan, Himachal Pradesh, India
  • Kushla Pathania Department of Obstetrics and Gynecology, Kamla Nehru Hospital for Mother and Child IGMCH Shimla, Himachal Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20195356

Keywords:

Bacterial vaginosis, Cervical cancer screening, Pap smear, Pregnancy, Preterm labour

Abstract

Background: The Papanicolaou test is a method of cervical screening used to detect pre-cancerous and cancerous processes. The incidence of cervical cancer in India is alarmingly high and is the leading cause of cancer in women in India accounting for 147 deaths per lakh women. Cervical cytological abnormalities are found in up to 5% of all pregnancies. In Indian settings, published data on abnormal Pap smear in pregnancy is lacking. The present study was designed to know the prevalence of abnormal Pap smear in pregnant women and its associated risk factors.

Methods: This prospective study included 450 pregnant and 450 non-pregnant women who fulfilled the inclusion criteria. After a detailed history, clinical examination and investigations, Pap smear was collected as per conventional method and reported using 2014 Bethesda system.

Results: 53.6% pregnant and 44.6% non-pregnant subjects had abnormal Pap smear. Out of the abnormal smears in pregnant women, 31.18% had inflammatory cytology, 15.37% had bacterial vaginosis, 4.01% had Trichomonal and 3.34% Monilial pathology. No epithelial cell abnormality was seen. Rural residence, lower class, age at first intercourse less than 21 years and having more than one sexual partner were important risk factors observed in our study and were statistically significant.

Conclusions: Bacterial vaginosis, the most common infection detected on Pap smear is strongly associated with previos preterm labour and delivery. This opportunity for screening of cervical cancer and counselling should not be missed in the antenatal period.

References

National Centre for Disease Informatics Research. National Cancer Registry Programme, ICMR Three Year Report of Population Based Registries, 2009-2011. Available at: https://www.icmr. nic.in/sites/default/files/reports/Preliminary_Pages_web.pdf. Accessed on 10th August 2016.

Summary report on HPV and cervical cancer statistics in India 2007.WHO/ICO Information Centre on HPV and Cervical Cancer. Available at: http://www.who.int/hpvcentre. Accessed on May 1st 2008.

Morice P, Uzan C, Gouy S, Versharaegen C, Haie-Meder C. Gynaecological cancers in pregnancy. Lancet. 2012;379:558-69.

Himabindu P, Kanwal A, Vasudha. Pap Smear In Antenatal Women - Routine Screening In Low Resource setting. Int Org Sci Res J Dent Med Sci (IOSR-JDMS). 2015;14(3):4-5.

Hunter MI. Monk BJ. Cervical neoplasia in pregnancy. Part 1: screening and management of preinvasive disease. Am J Obstet Gynaecol. 2008:3-8.

Ferenczy A, Franco E. Cervical-cancer screening beyond the year 2000. Lancet Oncol. 2012:27-32.

Nelson DB, Bellamy S, Nachamkin I, Ruffin A, Allen-Taylor L, Friedenberg FK. Characteristics and pregnancy outcomes of pregnant women asymptomatic for bacterial vaginosis. Matern Child Health J. 2008;12:216-22.

District level household and facility survey-3, Reproductive and Child Health Project, 2007-2008. Available at: http://rchiips.org/state-fact-sheet-rch3.html. Accessed on 8th August 2016.

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.

Arora BB, Maheshwari M, Devgan N, Arora DR. Prevalence of trichomoniasis, vaginal candidiasis, genital herpes, chlamydiasis, and actinomycosis among urban and rural women of Haryana, India. J Sex Transm Dis.2014;2014:963812.

Manikkam B. Screening for cervical cancer during pregnancy. Int J Community Med Public Health. 2016;3(9):2493-8.

Ajah LO, Chigbu CO, Ozumba BC, Oguanuo TC, Ezeonu PO. Is there any association between hormonal contraceptives and cervical neoplasia in a poor Nigerian setting? Onco Targets Ther. 2015;9:1887-92.

Desai Veena A, Ragini V, Preet MP. Bacterial Vaginosis in patients with Idiopathic preterm labour. J Obstet Gynaecol India. 2009;59(1):53-7.

Prabhu TRB, Velayudham D, Nethaji S, Singhal H, Venkatachalam R. Opportunistic cervical cancer screening in pregnancy. Int J Med Res Health Sci. 2016;5(1):278-81.

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Published

2019-11-26

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Original Research Articles