The "Gynaecology Update" has been established since 1997 for Primary Care and Community Health Practitioners
The "Update" issues can be searched either chronologically through the "Update" isssues section or through the search engine. They can also be searched under different topic headings e.g. Urogynaecology, Menopause, etc.
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National Recognition for a specialized Gynaecology Team
Recent "Update" Issue
Cervical screening and Colposcopy in Pregnancy
Issue 63 PDF format
Many pregnant women don’t attend their colposcopy appointment because they thinks that the examination is contraindicated during pregnancy specially if it was their first visit. I will discuss the indication for cervical screening and colposcopy in pregnancy and their safety
Cervical screening in pregnancy
Unless a pregnant woman with negative history has gone beyond three years without having cervical screening then the test should be postponed.
If a woman has been called for routine screening and she is pregnant then the test should be deferred.
If a previous test was abnormal, and in the interim the woman becomes pregnant, then the test should not be delayed but should be taken in mid-trimester unless there is a clinical contraindication.
Colposcopy in pregnancy
A woman who meets the criteria for colposcopy still needs colposcopy if she is pregnant. The primary aim of colposcopy for pregnant women is to exclude invasive disease and to defer biopsy/treatment until the woman has delivered. Women seen in early pregnancy may require a further assessment in the late second trimester. The safety of delaying treatment of pregnant women has been shown in a number of cohort and retrospective uncontrolled studies The incidence of invasive cervical cancer in pregnancy is low and pregnancy itself does not have an adverse effect on the prognosis.
If colposcopy has been performed during pregnancy, postpartum assessment of women with an abnormal smear or biopsy proven CIN is essential. Excision biopsy in pregnancy cannot be considered therapeutic and these women should be seen for colposcopy postpartum.
Safety of Colposcopy in pregnancy
Biopsies and treatment are normally deferred until after delivery in the vast majority of cases. Speculum and coloposcopic examination should not affect the course of normal pregnancy. In rare cases where invasive cancer is suspected the colposcopist will discuss with patient the possible risks associated with taking biopsies (mainly bleeding) before deciding on any action
Reference
Guidelines for the NHS Cervical Screening Programme, NHSCSP April 2004
Recent "Update" Issue
Cervical Screening: Questions and Answers
Issue 60 PDF format
The incidence of cervical cancer in England and Wales fell by 42%.
This fall is related to the cervical screening programme and the
rapid increase in coverage of the programme that occurred from
1989 onwards. The initial age for screening and the frequency are
shown in the table. The following are few questions on different
clinical situations and their associated answers. Please review the
“Update” issues 36, 56 & 59 as well
1- A 67 year old woman comes to see you. She asks you about cervical screening but you explain that
she is outside the age range for screening. However, she has never had a cervical screening test because
she was somehow missed out. Which one of the following statements is correct?
a. She should not have a cervical screening test
b. She should have a cervical screening test if she wants to, after having an informed discussion
2- A 35 year old woman is two months pregnant. She is called for a cervical screening test. Which
one of the following statements is correct?
a. You should not carry out cervical smear tests on pregnant women
b. You should not carry out liquid based cytology on pregnant women
c. Colposcopy is safe in pregnant women
3- A 36 year old woman comes to see you because she has just been called for a cervical screening
test. She has a mild learning disability. She attends with her carer. She has lived in residential care
since she was 17. Which one of the following statements is correct?
a. Women with a learning disability will not be able to cooperate with cervical screening
b. Cervical screening is likely to make her unduly anxious
c. Many women with learning disabilities are able to make an informed choice about whether to have cervical screening
d. It is unlikely that she has ever been sexually active and so cervical screening is inappropriate
4- A 48 year old woman receives an appointment for a cervical screening test. She is new to the area
and tells you she had cervical cancer in the past. She is unsure what treatment she had but is certain
she had radiotherapy for the cancer. Which one of the following statements is correct?
a. She should still have a smear test or liquid based cytology
b. She is unsuitable for a smear test or liquid based cytology
5- A 28 year old woman is invited for cervical screening. When she attends she tells you she has
never been sexually active with a man. Which one of the following statements is correct?
a. She should be completely withdrawn from the screening programme
b. Her chance of having cervical cancer is moderate
c. She may choose to decline the invitation for screening on this occasion
6- Which one of the following statements about the human papilloma virus is correct?
a. Most women infected with the virus go on to develop cervical cancer
b. Women with new changes to their cervix are likely to have been infected with the virus in the last year
c. Most women will naturally expel the human papilloma virus
Answers:1/b- 2/c- 3/c- 4/b- 5/c- 6/c