Pap tests and subsequent treatment during pregnancy and childbirth

It is recommended to take a Pap smear before conception of a child , as well as undergo any types of treatment, if necessary. If you are already pregnant and want to take a Pap smear, your doctor will discuss its implementation. Sometimes a woman and her doctor decide to postpone the Pap test until the postpartum check 6-8 weeks after the birth of the child, especially if the previous Pap tests were normal.

Pap tests and their effects

Pap tests during pregnancy are safe, and in most cases, treatment (in case of abnormal results) can be left until the baby is born. If a Pap smear shows that CIN may be present, pregnancy will not affect the course of any cellular changes, but colposcopy will probably be recommended. Colposcopy and puncture biopsy are considered safe procedures during pregnancy and are not considered to increase the risk of miscarriage or premature birth.

During pregnancy, glandular cells from inside the cervix (endocervical cells) naturally move deep into the cervix. This makes it difficult for medical staff to access them during the Pap test. A medic can place a small brush directly into the cervix to try to get to these cells. If access to endocervical cells is not possible, the pap test result will have the note “absence of endocervical tissue”. Depending on your previous Pap tests, your doctor may recommend repeating the Pap smear after the baby is born.

Pap tests performed within 6 weeks after delivery often reveal inflammation. This may be because a woman has thrush or gardnerella (often in the first weeks after birth) or the cervix is still healing. For this reason, some experts recommend postponing the postpartum check and Pap smear until the ninth week after delivery. Or repeat the Pap test after 3 months if the results indicate “inflammation”.

What is the danger of treatment

In addition to Pap smears and colposcopy, no other medical procedures are recommended during pregnancy, except in cases of extreme necessity. In most cases, any treatment can be postponed until the birth of the child (if required).

Long-term studies have shown that diathermy does not affect a woman’s fertility or her ability to give birth. Diathermy does not increase a woman’s chances of miscarriage or premature birth.

Surgical cone biopsy and laser conization have some risks of side effects. However, laser conization tends to have fewer of these side effects compared to cone biopsy. Although these effects are not common, they are possible for some women and may be as follows:

• Removal of mucosal-producing cells inside the cervix. This may prevent a woman from using the vaginal mucosa as a physical sign to determine when she is most fertile.
• The strength of the cervix is changing. In rare cases, a biopsy can weaken the cervix and make it difficult to have a baby, which can lead to a late miscarriage or premature birth. A healthcare professional may recommend suturing the cervix around the twelfth week of pregnancy and removing it later.
• Scars on the inside of the cervix and narrowing of the opening. This may affect the ability of the cervix to expand effectively during labor. In some women, the opening of the cervix is so narrowed that the menstrual cycle can slow down, increasing the period of pain.
• Infections of the uterus. Vaginal infections can more often affect the uterus, since the protective function of the cervix is currently practically absent. Severe uterine infections that do not receive timely treatment can damage a woman’s fallopian tubes and lead to infertility (although this rarely happens).