A colposcopy can be performed during pregnancy. It is often recommended to investigate abnormal cervical changes, balancing diagnostic needs with the safety of both the pregnant individual and the developing fetus.
Is Colposcopy Safe During Pregnancy?
Colposcopy is considered safe during pregnancy when performed by an experienced healthcare provider. The colposcope, a magnifying device, remains outside the body, providing a magnified view of the cervix, vagina, and vulva without internal penetration. Its primary goal is to rule out invasive cancer.
Physiological changes during pregnancy, like increased cervical blood flow, can increase bleeding risk if a biopsy is performed. However, colposcopy with biopsy during pregnancy is not associated with adverse surgical or obstetric outcomes. The American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines support its safety.
Reasons for a Colposcopy While Pregnant
A colposcopy is performed during pregnancy for abnormal Pap test results, such as high-grade squamous intraepithelial lesion (HSIL) or atypical glandular cells (AGC). While concerning, an abnormal Pap test does not confirm cancer; about 3-6% of Pap tests during pregnancy are abnormal. The procedure assesses the severity of these cells and indicates invasive cancer, which occurs in about 1 in 2000 to 2200 pregnancies. Colposcopy is also recommended for visible cervical lesions, suspected human papillomavirus (HPV) infection, or unexplained genital bleeding after other causes are ruled out.
What to Expect During the Procedure
The colposcopy procedure for pregnant individuals is similar to that for non-pregnant individuals, with modifications. You will lie on an examination table with your feet in stirrups, like a standard pelvic exam. A speculum is inserted to hold the vaginal walls open, providing a clear view of the cervix.
A colposcope, a microscope with a light, is positioned near the vaginal opening to magnify the view of the cervix, vagina, and vulva. A vinegar solution (acetic acid) is applied to the cervix with a cotton swab; this helps abnormal areas turn white and become more visible. This application may cause a slight burning sensation but is a key diagnostic step.
If suspicious areas are identified, a small tissue sample (biopsy) may be taken. During pregnancy, biopsies are limited to areas highly suspicious for invasive cancer due to increased cervical vascularity, which can cause more bleeding. Endocervical curettage (ECC), scraping the inside of the cervical canal, is avoided due to the risk of disrupting the pregnancy or causing injury. The procedure usually takes 10 to 15 minutes.
Managing Abnormal Results During Pregnancy
If abnormal findings are present after a colposcopy during pregnancy, the approach is careful observation rather than immediate treatment. Most cervical changes detected during pregnancy progress slowly, and many minor cellular changes return to normal after delivery. The primary goal is to exclude invasive cancer.
Individuals diagnosed with high-grade lesions, such as CIN 2 or 3, or adenocarcinoma in situ (AIS) during pregnancy, are monitored through repeat colposcopy and cytology testing every 12-24 weeks. Treatment for precancerous lesions is deferred until after delivery, ideally around 8 weeks postpartum. If invasive cancer is suspected, treatment may be considered during pregnancy, potentially involving referral to a gynecological oncologist for assessment.