Colposcopic assessment of the normal cervix in pregnant women
Authors: Lygyrda N.F. 
Published: July 2021

Background. Colposcopy in a pregnant woman is carried out to rule out the presence of invasive cervical cancer and to determine the need for targeted biopsy. Indications for colposcopy include pathological cytological smear, abnormal appearance of cervix, or bleeding of unknown origin.

Objective. To describe the features of colposcopic examination in pregnant women.

Materials and methods. Analysis of own experience and literature sources on this topic.

Results and discussion. Literature data indicate the reliability and safety of colposcopic examination of pregnant women. It should be noted that the examination of pregnant women requires a higher qualification from the colposcopist than the examination of non-pregnant women, although the assessment is based on the same principles. Simple colposcopy allows to assess the vascular pattern and color of the epithelium. For a more thorough assessment acetic acid and aqueous Lugol solution probes are carried out. The tasks of colposcopy are to identify the causes of deviations from the norm of cytological examination, to determine the location and boundaries of the pathological area, to choose the location of the targeted biopsy, to carry out medical manipulations within healthy tissues, and to monitor treatment results. To improve the planning of the necessary treatment options for excisions, a Nomenclature of colposcopic terms for cervix was created. Features of the cervix in pregnant women include the increased cervix vascularization, edema and hypertrophy of the papillae of the cervical canal, increased secretory activity of the cervical canal, eversion of the cervical mucosa, dehiscence of the cervical canal, increased metaplasia, deciduosis, prolapse of the vaginal walls. These physiological changes may cause overdiagnosis of pathological conditions. Thus, hypervascularization can mimic atypical vessels, and deciduosis – malignant tumors. Conversely, hypervascularization and bleeding, increased mucus production and prolapse of the vaginal walls can mask the manifestations of the disease, being the causes of underdiagnosis. The progression of eversion during pregnancy allows to visualize the lesion, which was previously localized in the cervical canal, better and better. Deciduosis in pregnant women is divided into decidual ectopia and decidual polyps of the cervical canal. The tumor-like form of deciduosis visually and colposcopically mimics exophytic tumors. The ulcer form is characterized by dense whitening when applying acetic acid, but is not stained with Lugol solution. Manifestations of the papillary form become the most pronounced after the acetic acid test. The vesicular form is the most common and most easily diagnosed by colposcopists. Decidual polyps become densely whitened during the acetic acid test, but unlike cervical cancer, blood vessels do not disappear. These polyps are not stained with iodine. Decidual polyps are usually localized in the areas of the original epithelium; they are multifocal and small in size. Instead, malignant tumors are localized within the atypical zone of transformation; they are single and have a bumpy uneven surface. Polymorphism and variety of lesions, young age, pregnancy, normal results of cytological examination are more typical for deciduosis. If the colposcopist is unsure of the benign nature of the process, a targeted biopsy should always be performed.

Conclusions. 1. The purpose of colposcopy in a pregnant woman is to rule out the presence of invasive cervical cancer and to determine the need for targeted biopsy. 2. Indications for colposcopy include pathological cytological smear, abnormal cervix appearance, or bleeding of unknown origin. 3. Physiological changes during pregnancy can be the cause of hyper- and hypodiagnosis of pathological conditions. 4. If the colposcopist is unsure of the benign nature of the process, a targeted biopsy should always be performed.