pregnant pt with HGSIL - sami

[ArchivalUser]

on pap smear how do you manage

[ArchivalUser]

PAP SMEAR SCREENING AND FOLLOW-UP
PAP SMEAR RESULTS:
ASCUS
F/U pap smear q 4-6 months for 2 years.
- if returns to normal X3 then return to usual yearly screening exam
- if persistent or recurrent ASCUS or a LGSIL develops proceed to colposcopy
- if patient at high risk, not reliable to return for follow-up or there is concern about following ASCUS,
proceed to colposcopy
LGSIL
1. Proceed to colposcopy with directed biopsy of abnormal areas and ECC
2. F/U pap smear q 4-6 months for 2 years.
- if returns to normal X3 then return to usual yearly screening exam
- if persistent LGSIL or higher grade lesion proceed to colposcopy
HGSIL
Proceed to colposcopy for directed biopsy and ECC

COLPOSCOPY RESULTS:
ATYPICAL - REACTIVE- INFLAMMATION
- continue to follow with pap smears and consider repeating colposcopy if ASCUS persists, proceed to repeat
colposcopy if higher grade lesion develops
LGSIL
- If entire lesion can be identified and patient is not at High Risk and is reliable for follow up, watching lesion can
be considered (60% of patients with LGSIL will spontaneously regress).
- local excision or ablation of atypical area when entire lesion cannot be visualized (laser, cryoRX, LEEP excision)
in a non-pregnant patient
HGSIL
- Complete excision or ablation of entire abnormal area and transformation zone is recommended in a non-pregnant
woman
- If entire lesion and transformation zone cannot be visualized conization is usually indicated
- If the patient is pregnant, the diagnostic evaluation should be modified. If invasive carcinoma is not present,
definitive treatment may be deferred until after pregnancy is completed. Conization is rarely needed during pregnancy.

INVASIVE CARCINOMA
- Proceed to definitive therapy

Definitions:
High Risk: Patient who has a history of abnormal pap smears, dysplasia or carcinoma or is not reliable to return for follow up visits.
LGSIL: Low grade squamous intra-epithelial lesion, HPV changes, mild dysplasia, CIN 1
HGSIL: High grade squamous intra-epithelial lesion, moderate to severe dysplasia/carcinoma-in-situ , CIN 2-3