임신 중 발견된 자궁경부 이형성증(CIN)의 치료

Cervical dysplasia in pregnancy: progression versus regression postpartum, 임신 중 발견된 자궁경부 이형성증의 치료

분만전 자궁경부 이상이 발견된 산모 중 분만후 약 63-76%가 등급이 낮아졌습니다.
그러므로 산모의 자궁경부 이형성증은 conservative하게 치켜보는 것이 최선이라고 하겠습니다.

 단, 침윤성 암이 의심되는 경우 원추절제술을 시행합니다.

Gazala Siddiqui MD, Richard B. Kurzel MD, E. Charles Lampley MD, Hyung S. Kang MD and Josef Blankstein MD

Mount Sinai Hospital, Finch University of the Health Sciences, the Chicago Medical School, Chicago, IL, USA

Abstract

Objective: To study the natural history of cervical dysplasia diagnosed during pregnancy, in terms of progression or regression postpartum, by the severity of the lesion.
Method: A retrospective review of abnormal Pap test results in pregnancy was performed from October 1996 to April 2000. One hundred patients had antepartum Pap tests and colposcopy, as well as colposcopy postpartum, for inclusion in the study. Groups were classified as HGSIL, LGSIL, or ASCUS. The significance of the rate of change of lesion grade was tested using the χ² and Fisher exact tests.
Results: One hundred patients with abnormal Pap test results were confirmed colposcopically to be HGSIL (30%), LGSIL (53%), and ASCUS (17%). Six patients with HGSIL grade lesion: HGSIL (3% to CIS), LGSIL (2%), and ASCUS (6%). No change in the grade of lesion was seen for HGSIL (63%), LGSIL (64%), and ASCUS (76%). Regression rates for patients with HGSIL and LGSIL were statistically significant (P <0.006). No microinvasive or frankly invasive lesions were seen in this study. Of six patients with CIS antepartum, none progressed to invasion, and two regressed to LGSIL.
Conclusion: A low progression rate of cervical dysplasia during pregnancy allows for conservative management with postpartum follow-up. Regression rates postpartum are high (63–76%) for all grades of lesions.