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Cervical cytology results among pregnant and non-pregnant women in Brazil

Published:January 23, 2023DOI:https://doi.org/10.1016/j.ejogrb.2023.01.027
Cervical cytology results among pregnant and non-pregnant women in Brazil
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      Abstract

      Objective

      To compare the prevalence of abnormal cervical smear results among pregnant and non-pregnant women with and without representation of the transformation zone (TZ) in a mid-sized city in Brazil.

      Study design

      This observational analytical and retrospective study analyzed cervical smear results from pregnant and non-pregnant women in a mid-sized city in Brazil. Private data were collected at private clinics over seven years and from public services over 16 years. All results were reported according to Bethesda System. Pregnant women were separated from non-pregnant women, and women were stratified into two age groups (25–29 years and 30–34 years) in general analyses. For TZ representation and cytologic-histologic correlation, there was no age stratification.

      Results

      Among public services cervical smears, the frequency of atypical squamous cells of undetermined significance (ASC-US) was higher for pregnant women in the entire group (odds ratio [OR] 1.91; confidence interval [CI] 1.07–3.39) and among women from 30 to 40 years old (OR 2.79; CI 1.38–5.66). The same occurred for low-grade squamous intraepithelial lesion (LSIL) in the total group (OR 3.50; CI 1.44–8.53) and among women 30 to 40 years old (OR 4.57; CI 1.45–14.42).
      The frequency of ASC-US was higher in pregnant women with TZ representation exams than those without (OR 4.62; CI 2.17–9.84). The same occurred for those with atypical squamous cells, which cannot exclude high-grade squamous intraepithelial lesion (OR 9.81; CI 1.63–59.15) and LSIL (OR 10.47; CI 3.39–32.36).
      Among pregnant women with abnormal cervical smear results, 85.74% were followed up through cytology, and an average of 26.12% of patients underwent biopsy, of which almost all were positive for dysplasia.

      Conclusion

      Pregnant and non-pregnant women did not differ in cervical smears with actual precursor lesions. Nevertheless, considering the opportunistic nature of Brazilian cervical cancer screening, prenatal visits present an opportunity to perform cervical smears in pregnant women. TZ representation correlated with higher rates of abnormal cervical smears, reinforcing the clinical importance of endocervical/metaplastic cell representation, including among pregnant women.

      Keywords

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      Article info

      Publication history

      Published online: January 23, 2023
      Accepted: January 22, 2023
      Received in revised form: January 18, 2023
      Received: October 29, 2022

      Identification

      DOI: https://doi.org/10.1016/j.ejogrb.2023.01.027

      Copyright

      © 2023 Elsevier B.V. All rights reserved.

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