Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy

Yvan Gomez; Vincent Balaya; Karine Lepigeon; Patrice Mathevet; Martine Jacot-Guillarmod

doi:10.3390/jcm10225319

Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy

J Clin Med. 2021 Nov 15;10(22):5319. doi: 10.3390/jcm10225319.

Authors

Yvan Gomez^{1

2}, Vincent Balaya^{1

3}, Karine Lepigeon^{1

2}, Patrice Mathevet^{1

2}, Martine Jacot-Guillarmod^{1

2}

Affiliations

¹ Colposcopy Unit, Women-Mother-Child Department, Lausanne University Hospital, 1011 Lausanne, Switzerland.
² Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland.
³ Department of Gynecology and Obstetrics, Foch Hospital, 92150 Suresnes, France.

Abstract

Objective: The aim of this study was to describe the evolution of high-grade cervical dysplasia during pregnancy and the postpartum period and to determine factors associated with dysplasia regression.

Methods: Pregnant patients diagnosed with high-grade lesions were identified in our tertiary hospital center. High-grade lesions were defined either cytologically, by high squamous intraepithelial lesion/atypical squamous cells being unable to exclude HSIL (HSIL/ASC-H), or histologically, with cervical intraepithelial neoplasia (CIN) 2+ (all CIN 2 and CIN 3) during pregnancy. Postpartum regression was defined cytologically or histologically by at least a one-degree reduction in severity from the antepartum diagnosis. A logistic regression model was applied to determine independent predictive factors for high-grade cervical dysplasia regression after delivery.

Results: Between January 2000 and October 2017, 79 patients fulfilled the inclusion criteria and were analyzed. High-grade cervical lesions were diagnosed by cytology in 87% of cases (69/79) and confirmed by histology in 45% of those (31/69). The overall regression rate in our cohort was 43% (34/79). Univariate analysis revealed that parity (p = 0.04), diabetes (p = 0.04) and third trimester cytology (p = 0.009) were associated with dysplasia regression. Nulliparity (OR = 4.35; 95%CI = (1.03-18.42); p= 0.046) was identified by multivariate analysis as an independent predictive factor of high-grade dysplasia regression. The presence of HSIL on third-trimester cervical cytology (OR = 0.17; 95%CI = (0.04-0.72); p = 0.016) was identified as an independent predictive factor of high-grade dysplasia persistence at postpartum.

Conclusion: Our regression rate was high, at 43%, for high-grade cervical lesions postpartum. Parity status may have an impact on dysplasia regression during pregnancy. A cervical cytology should be performed at the third trimester to identify patients at risk of CIN persistence after delivery. However, larger cohorts are required to confirm these results.

Keywords: ASC-H; CIN; HSIL; cervical cancer; cervical intraepithelial neoplasia; high-grade dysplasia; pregnancy.