妊婦の頚部細胞診異常の取り扱いについて

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  • Management of pregnant women with abnormal cervical cytology.

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During the past three years, 2972 pregnant women received cytologic screenings for uterine cervical cancer using a cotton-tipped aplicator or moistened cotton ball. The cytodiagnoses revealed class III a in 16 (0.54%) cases, class III b in 4 (0.13%) cases and class IV in 2 (0.07%) cases.If possible, we should avoid cervical conization for pregnant women even in cases with abnormal cervical cytology. Thus, we dare not carry out cervical conization unless there is evidence of progressive cancer cytologically or colposcopically.Out of 2 cases who showed class IV at initial cytodiagnosis, one showed CIS and the other showed severe dysplasia when examined by punch biopsy.They received conservative follow-up without conization.They continued to be class IV cytologically and revealed CIS on total hysterectomy and conization in the puerperal period. In this study, there were no cases suspected to be progressive cancer.Our management plan for pregnant women with abnormal cervical cytology is useful in that it avoids various complications due to cervical conization of pregnant woman. It is, however, necessary to investigate the risk of underestimating invasive cancer.

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