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Regular cervical cancer screening, cervical cancer screening before pregnancy
At present, with the change of people's living habits, HPV infection shows a trend of rejuvenation. More critically, the reproductive age period is the high incidence of HPV infection, and the proportion of women with HPV infection during pregnancy is reported to be about 40%.
When pregnancy encounters HPV infection, how should expectant mothers face it?
01
HPV infection tends to occur during pregnancy
Pregnancy is already difficult, why does HPV have to be mixed?
HPV infection tends to occur during pregnancy for the following reasons:
Changes in the level of hormones during pregnancy, immune function is suppressed, it is difficult to clear HPV;
Abundant blood supply to the pelvic and reproductive organs during pregnancy, increased vaginal secretions, increased susceptibility to bacteria and viruses;
Affected by the hyperplasia status of cervical epithelial cells during pregnancy, hyperplasia of cells in the substratum and subbasic layer of the cervical complex layer during pregnancy, increased mucus secretion of cervical glands, activation of cervical epithelial metaplasia. In addition, the columnar epithelium moves more towards the vaginal side of the cervix and is sensitive to different factors, including HPV infection.
02
Does HPV infection affect the fetus?
In vitro experiments have found that HPV infection of the reproductive tract inhibits the proliferation of placental trophoblasts, promotes apoptosis of trophoblasts, and prevents the adhesion of trophoblasts to endometrial cells. Therefore, it may lead to premature rupture of membranes, and even related to miscarriage caused by placental factors, preterm birth, intrauterine growth restriction of the fetus, low birth weight infants, etc., but the relevant conclusions are still controversial and need further research.
However, there is already evidence that HPV can be transmitted vertically to the fetus/newborn, especially during vaginal delivery.
However, despite the presence of NEONA AND PAV infections, HPV has not been closely associated with neonatal or any systemic infections in children. Neonatal HPV infection tends to disappear within two years, and a small proportion may persist, leading to skin and genital warts and, in some cases, recurrent respiratory papillomas in adolescents.
03
Can neonatal infection be prevented by caesarean section?
The study found that caesarean section can reduce vertical transmission by 46%, but it does not completely prevent the occurrence of vertical transmission, because there are still ways for HPV to be transmitted through the placenta, fetal membrane and amniotic fluid.
Interestingly, although caesarean section reduces the vertical transmission of HPV by about half compared to vaginal births, the American Association of Obstetricians and Gynecologists recommends that the benefits of vaginal births and the fact that neonatal HPV infections mostly disappear spontaneously, and there is no need to deliberately require a caesarean section in order to worry about HPV infection.
04
How is HPV diagnosed and treated during pregnancy?
Patients with HPV infection detected during pregnancy should be further tested in conjunction with TCT screening results. If there is no abnormality in the TCT test, invasive treatment such as colposcopic biopsy is not performed in principle. However, HPV and TCT should be reviewed promptly after childbirth, and the treatment principle is the same as that of nonpregnant women.
Pregnant women with abnormal TCT test results during pregnancy have different test results and different management principles:
▌ TCT test result is ASCUS (atypical squamous cells of no clear significance)
When HPV is found positive, the likelihood of biopsy finding CIN2/3 is low. Women with ASCUS or low-grade squamous intraepithelial lesions (LSIL) had CIN2/3 in biopsies in 10% to 25.6%. The likelihood of finding invasive cervical cancer is even lower, estimated at less than 1%. Therefore, the diagnosis and treatment in "OR" can be performed, but postpartum management is preferred.
Figure 1: TCT test results during pregnancy are for administration of ASCUS.
Note: PP (postpartum), postpartum.
▌ TCT test result is LSIL (low-grade lesions in the squamous epithelium)
Patients with LSIL cytology results are highly unlikely to have high-grade histologic lesions or invasive cancers. There is also evidence that CIN1 lesions have a high rate of resolution in the postpartum period and a higher rate of resolution in younger patients. Therefore, for those younger than 24 years of age, it is recommended to have t CT tested again after 1 year, while for those older than 25 years, colposcopy during pregnancy is still the preferred method of evaluation of LSIL, but it is acceptable to postpone the evaluation until 6 weeks postpartum.
Figure 2: TCT test results during pregnancy are for management of LSIL.
▌ TCT test result is HSIL (squamous intraepithelial high degree of lesion)
All women with high-grade cytology should have a colposcopic evaluation during pregnancy. Biopsy should be performed for all suspicious lesions, but cervical tube curettage should not be performed. The risk of finding invasive carcinoma is estimated at 1%. If colposcopy specialists cannot rule out infiltrates under colposcopy, it has been suggested that resection should be performed in addition to a directional biopsy to confirm the diagnosis.
▌ Glandular epithelial abnormalities
Cervical in situ adenocarcinoma and primary adenocarcinoma are uncommon, accounting for only 15% of all cervical tumors. For nonpregnant women, atypical glandular cells are usually examined by colposcopy, cervical canal curettage, and endometrial biopsy. Colposcopy is recommended for patients with atypical glandular cell (AGC) and adenocarcinoma in situ (AIS), but cervical canal aspiration and endometrial biopsy are not.
In addition, pregnant mothers do not have to worry about pregnancy will aggravate HPV infection. Although the immune function of pregnancy is relatively low, there is currently no evidence of statistical differences in the development of HPV infection and non-pregnancy in pregnant patients.
In short, HPV infection during pregnancy has certain harm to the mother and fetus, for the health of themselves and the baby, please remember to regular cervical cancer screening, cervical cancer screening before pregnancy.
bibliography:
[1] Chilaka VN,Navti OB,Al Beloushi M,Ahmed B,Konje JC. Human papillomavirus(HPV)in pregnancy-An update. Eur J Obstet Gynecol Reprod Biol.2021.264:340-348.
[2] Pandey D,Solleti V,Jain G,et al. Human Papillomavirus(HPV)Infection in Early Pregnancy:Prevalence and Implications.Infect Dis Obstet Gynecol.2019.2019:4376902.
[3] Lu DW,Pirog EC,Zhu X,Wang HL,Pinto KR. Prevalence and typing of HPV DNA in atypical squamous cells in pregnant women. Acta Cytol.2003.47(6):1008-16.
[4Jody Stonehocker.Cervical Cancer Screening in Pregnancy.
Shanghai Municipal Science and Technology Commission Science Popularization Project Grant (Project No.: 20DZ2311000)
Source of this article: Medical Community Obstetrics and Gynecology Channel