Abnormal Cervical PAP Smear in Pregnancy

If you have never had a cervical Pap smear (also known as cervical cytology or cervical smear), or it has been a few years since your last test, your doctor or midwife will likely perform one at your first  pregnancy visit (click for more on what happens at your first visit). The test is painless, done by taking a swabbing of the cervix to collect a few cells. These are examined at an outside laboratory to look for the presence of abnormal cells. Occasionally, the test comes back showing atypical cells of undetermined significance or abnormal-appearing cells, both of which will require further investigation.

Common, non-cancerous things that can cause abnormal results are:

  • Infection with HPV – Human Papilloma Virus (many cases now preventable with HPV vaccines such as Gardasil)
  • Trichomoniasis or Herpes (other common sexually transmitted diseases)
  • Yeast Infection
  • Inflammation/irritation
  • Recent intercourse

HPV infection is the predominant cause and risk factor for abnormal cervical Picture of slide with normal cervical cells versus cells with HPVcells to develop into cervical cancer. However, even if you test positive for HPV, most cases do NOT progress to cancer. Most of the time, your body will fight and clear the infection on it’s own. Abnormal or dysplastic cells, if found, can be treated and removed before they become cancerous.

What happens if the Cervical PAP Smear is Positive?

Most of the time, positive results indicate inflammation or infection, NOT cancer. However, in order to further evaluate exactly what is going on, your doctor will likely do a colposcopy. Colposcopies are safe in pregnancy and will not harm you or your developing baby. It is done by having you lie on your back with legs apart, just like the cervical smear. The doctor will use a colposcope which is essentially a magnifying lens with a bright light to take a better look at your cervix. Some vinegar (acetic acid) will be swabbed onto the cervix which will turn white on any abnormal areas. This may make you feel and smell like a salad, but it is painless and harmless. If any suspicious areas are identified, the doctor can take small samples of tissue, known as biopsies, from those areas which will be sent to a lab for evaluation. The biopsy (or biopsies) may be mildly uncomfortable but again, they will not harm or threaten the pregnancy.

If the laboratory finds abnormal cells on biopsy, in the vast majority of cases, treatment can be delayed until after the birth of the baby. It is even possible that the birth will slough off the abnormal cells and a repeat cervical PAP smear and/or colposcopy will show no further treatment is necessary. However, if abnormal or cancerous cells persist, there are a few different treatment options. Your doctor will know which approach is best for you.

Briefly, potential treatments involve cryosurgery (freezing) of the abnormal cells which can be done in the office and is a relatively easy and painless procedure. You may also have a cone biopsy, which involves removing a triangular ‘chunk’ of tissue and  all the abnormal cells. Alternatively, a LEEP (loop electrosurgical excision prodecure) may be performed where a loop-shaped instrument ‘cores’ out the area of abnormality. If you have a LEEP or cone biopsy and you have any subsequent pregnancies, you will be at higher risk for your cervix to prematurely dilate, known as cervical incompetence. Make sure you tell your doctor about any prior cervical procedures when you become pregnant (if he/she doesn’t already know).  You may be a candidate for a cerclage (click for more info), which is a stitch placed in the cervix at approximately 13 weeks gestation.



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