Are colposcopy and minor procedures safe in pregnancy ?

Are colposcopy and minor procedures safe in pregnancy ? | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 12 December 2025 V1 Latest version Share on Are colposcopy and minor procedures safe in pregnancy ? Authors : Gunasagran Y 0009-0003-7618-5603 [email protected] , Jones C P , Naskretski A , Sinha A , Kenneth Lim , Howells R , Rzyska E , and Aarti Sharma Authors Info & Affiliations https://doi.org/10.22541/au.176553741.10077708/v1 360 views 279 downloads Contents Abstract Introduction Methods Results Discussion Conclusion References Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Objective: To evaluate incidence of cervical cancer and outcome of colposcopy and minor procedures during pregnancy on maternal and fetal outcomes. Design: Retrospective service evaluation. Setting: University Hospital of Wales, Cardiff, UK. Participants: Pregnant women referred for colposcopy between 2015 and 2024. Main outcome measures: Incidence of cervical cancer, colposcopy impressions, procedural interventions, and adverse maternal and fetal outcomes. Results: Among 359 referrals, colposcopy was performed in 92.2% (n = 331). Procedures were rare (3.9%), and adverse outcomes were low (10.6%), with no definitive link to procedural intervention. Conclusions: Colposcopy in pregnancy is safe when performed by experienced clinicians. A conservative approach to management remains appropriate, with vigilant follow-up to ensure timely diagnosis and treatment when necessary. Introduction The incidence of cervical cancer during pregnancy is estimated to be between 3.3 to 26 per 100,000 births.[1] With regular access to cervical screening, more pregnant women are being referred for colposcopy following abnormal smear results within early pregnancy. Similarly, women with any abnormality noted on cervix during pregnancy are also referred to colposcopy. Minor procedures such as cervical biopsy and colposcopy assessment are considered safe when performed by experienced clinicians and appropriately tailored to the stage of pregnancy.[2] However, data on maternal and fetal outcomes following such procedures remain limited, particularly regarding long-term impact.[3] The clinical goal during pregnancy is to balance the need for timely diagnosis and monitoring of cervical pathology while minimising unnecessary interventions that may compromise obstetric outcomes. This retrospective study aimed to assess the incidence of cervical cancer, frequency of colposcopic referrals, and impact of colposcopy or minor procedures on maternal and fetal outcomes across a large tertiary centre over a ten-year period. Methods A retrospective study of pregnant women referred for colposcopy between January 2015 and December 2024 at the University Hospital of Wales was conducted. Data were obtained from the Welsh Clinical Portal and Cancer Network Information System Cymru (CaNISC). No ethical approval was required for this study. Data was collected on referral indications, gestation of pregnancy at time of colposcopy, colposcopic impressions, procedures performed, and maternal and fetal outcomes. Descriptive statistics were used to summarise findings. Excel version 16.99.2 was used for the analysis. Patients or the public were not included in the design, or conduct, or reporting, or dissemination plans of our research. Results Baseline maternal characteristics are shown in Table 1. The mean maternal age at referral was 30.9 years (SD 4.9; range 20–45) and the mean gestational age at examination was 20 weeks and 2 days. Most women were non-smokers 266 (64.1%), with 73 (17.6%) ex-smokers, 52 (12.5%) current smokers, and smoking status unknown in 24 (5.8%). Pre-pregnancy abnormal cervical cytology was the most common indication for referral (56.4%), predominantly low-grade or borderline changes, followed by a clinically suspicious cervix (26.25) and suspicious symptoms (12.0%) (Table2). Among 359 referrals, colposcopy was performed in 92.2% (n = 331). Colposcopic assessment revealed predominantly benign findings: inflammatory changes (30.8%) or a normal cervix (26.9%). Mild precancer changes were observed in 22.1% and moderate to severe precancer changes in 12.1%. (Table3). Procedures during pregnancy were infrequent (3.9%). These included 6 polypectomies (all histologically benign), 7 biopsies (yielding CIN1 in three, CIN3 in one, HPV-related changes in two, and decidual/inflammatory changes in one), and 1 LLETZ procedure which revealed adenocarcinoma of the cervix.(Table 4) Delivery outcomes were unavailable for 15 women, who were therefore excluded from the outcome analysis. Among the remaining 316 women with known outcomes, 33 (10.4%) experienced adverse maternal or fetal events. Three of 14 women (21.4%) within the procedure group experienced adverse outcomes, compared with 30 of 302 (9.9%) in the non-procedure group. This difference was not statistically significant (Fisher’s exact test, p = 0.19) Within the procedure group, there was one miscarriage (biopsy at 18 weeks), one neonatal death (polypectomy at 22+1 weeks), and one preterm delivery (biopsy at 32+5 weeks). (Table 5). Discussion Colposcopy is performed for detailed examination of the cervix when screening or clinical findings suggest an abnormality. In pregnancy, it is indicated after an abnormal screening test done prior to pregnancy or as a follow up to a known pre-pregnancy dysplasia, when a previously abnormal cervix is discovered during antenatal care, or when suspicious symptoms arise. In this ten-year retrospective evaluation, colposcopy was performed in over 90% of pregnant women referred for abnormal cytology or suspicious symptoms. Just over a quarter were referred because of a clinically suspicious cervix. Most assessments showed benign or inflammatory changes, and only a small proportion required biopsy or treatment during pregnancy. Physiological changes of pregnancy—such as altered vascular patterns, increased mucus production, and eversion of the transformation zone—make colposcopy technically challenging. An experienced colposcopist is therefore essential.[3] Evidence continues to show that colposcopy in pregnancy, when performed by trained clinicians, is a safe and effective tool for managing abnormal cervical cytology.[4] The low intervention rate (3.9%) aligns with recommendations from the British Society for Colposcopy and Cervical Pathology (BSCCP), which advocate conservative management and careful follow-up rather than treatment during pregnancy, except in high‑risk cases.[3] Timing of colposcopy is important. When low‑grade or CIN1 disease is suspected, examination can be deferred until the postpartum period. If higher‑grade disease (CIN2/3) is suspected, repeat assessment is recommended at the end of the second trimester and again after delivery. Biopsies are generally deferred unless malignancy is suspected. Diagnosis of cervical cancer in pregnancy can be challenging.[5] The detection of a single cervical adenocarcinoma in this cohort underscores the importance of expert assessment and undertaking a biopsy when cancer is suspected. BSCCP states that excisional biopsies are safe in the first and second trimesters of pregnancy but should be undertaken in appropriate settings equipped to manage haemorrhage and other complications. Among the 14 individuals who underwent procedures, there were three adverse outcomes—a miscarriage, a neonatal death, and a preterm delivery. However, adverse outcomes were also observed among women who did not undergo procedures, reinforcing that these complications are multifactorial. A recent retrospective analysis of 2,814 women likewise found that colposcopy and biopsy in pregnancy were not associated with increased obstetric complications.[6] By contrast, a meta‑analysis by Kyrgiou et al. reported higher rates of preterm birth among women with CIN, especially after ablative or excisional treatment, although the evidence was based on low‑quality observational data and should be interpreted cautiously.[7] These findings contrast with BSCCP guidance, which considers excisional procedures safe in early pregnancy when clinically indicated. Cervical polyps are occasionally found during pregnancy, often incidentally during routine examination, though they may also present with post-coital bleeding or increased vaginal discharge. The risk of underlying malignancy is very low (≈0.1%). Although research in pregnancy is limited, the presence of a cervical polyp itself appears to increase the risk of infection, miscarriage and preterm delivery. A recent large meta-analysis showed that cervical polyps during pregnancy are associated with significantly higher rates of late miscarriage and preterm birth. Importantly, removal of endocervical or decidual polyps did not increase the risk of miscarriage or preterm delivery compared with conservative management. [8] However, when histology confirms a decidual polyp, the risk of adverse outcomes is higher if polypectomy was performed. As decidual change can only be confirmed histologically, if removal is clinically indicated it is recommended to defer polypectomy until after 12 weeks’ gestation. This study’s strengths include a large, consistently recorded cohort over a decade and a low loss to follow‑up. Limitations include its retrospective nature and incomplete information in some cases. Nonetheless, the findings reinforce the safety profile of colposcopy in pregnancy and support its continued use as part of antenatal care when indicated. Conclusion Adverse outcomes were not limited to individuals who underwent biopsy or treatment showing that colposcopy is safe in pregnancy. The low rate of adverse outcomes and interventions supports a conservative management approach and colposcopy with appropriate follow-up where indicated. A small number of individuals experienced complications despite not having an intervention, indicating that factors beyond procedural intervention contribute to complications. Although procedures were infrequent, these findings show the importance a clear and refined referral criteria and experienced colposcopist to minimise unnecessary interventions whilst maintaining cervical cancer detection standards. Continued vigilance remains necessary to ensure early cancer detection without compromising maternal and fetal wellbeing. Table 1. Baseline maternal characteristics of pregnant women referred for colposcopy (2015–2024) Mean maternal age, years (SD; range) 30.9 (4.9; 20–45) Mean gestational age at examination 20+2 weeks Non-smokers, n (%) 266 (64.1) Ex-smokers, n (%) 73 (17.6) Current smokers, n (%) 52 (12.5) Unknown, n (%) 24 (5.8) Table 2. Indications for referral to colposcopy during pregnancy Abnormal smear 211 (56.4) - Low-grade/borderline 133 (55.7 of abnormal) - High-grade 73 (30.5 of abnormal) - Glandular neoplasia 4 (1.7 of abnormal) - Other findings 29 (12.1 of abnormal) Clinically suspicious cervix 98 (26.2) Suspicious symptoms 45 (12.0) Other indications 20 (5.3) Table 3. Colposcopic impressions at initial assessment Normal 89 (26.9) Inflammatory 102 (30.8) Mild changes 73 (22.1) Moderate–severe changes 40 (12.1) Other 27 (8.2) Table 4. Procedures performed during pregnancy and histological outcomes Polypectomy 6 All benign Biopsy 7 CIN1 (3), CIN3 (1), HPV changes (2), decidual/inflammatory (1) LLETZ 1 Adenocarcinoma of cervix Table 5. Adverse maternal and fetal outcomes Procedure group Miscarriage (biopsy at 18w) 1 Neonatal death (polypectomy at 22+1w) 1 Preterm delivery (biopsy at 32+5w) 1 Non-procedure group Preterm birth 13 Miscarriage 16 Termination for fetal anomaly 1 Overall Adverse outcomes 10.4% References 1. 1. Smith LH, Dalrymple JL, Leiserowitz GS, Danielsen B, Gilbert WM. Obstetric outcomes in women with cervical cancer. *Obstet Gynecol* 2003;102(4):761–6. 2. Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, et al. 2012 ASCCP consensus guidelines for the management of abnormal cervical cancer screening tests in pregnancy. *J Low Genit Tract Dis* 2013;17(4 Suppl 1):S1–S27. 3. British Society for Colposcopy and Cervical Pathology. Abnormal smears during pregnancy [Internet]. 2025 [cited 2025 Sep 9]. Available from: 4. Simoens C, Goffin F, Simon P, Delbecque K, Barlow P, Noël JC. Colposcopy during pregnancy: results from a 12-year experience. *Eur J Obstet Gynecol Reprod Biol* 2015;188:48–52. 5. Sonoda K, Makabe T, Okamoto K, et al. Difficulty of cervical cancer diagnosis during pregnancy: a case series and literature review. Mol Clin Oncol 2021;15(6):276. 6. Lantsman TL, Cohen A, Gemer O, et al. Association between cervical dysplasia, colposcopic biopsy in pregnancy and adverse obstetric outcomes. J Low Genit Tract Dis 2020;24(3):243–8 7. Kyrgiou M, Athanasiou A, Paraskevaidi M, Mitra A, Kalliala I, Martin-Hirsch P, Arbyn M. Cervical cancer treatment and preterm delivery risk: systematic review and meta-analysis. *BMJ* 2016;354:i3633. 8. Wang M, Ye M, Shen N, Pan W, Zhang H, Wang X, et al. Management of pregnant women with endocervical and decidual polyps: a systematic review and meta-analysis. Arch Gynecol Obstet. 2025;312(2):375-84. Crossref Google Scholar Information & Authors Information Version history V1 Version 1 12 December 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords carcinoma of the cervix: diagnosis colposcopy cytology: cervical early pregnancy gynaecological oncology Authors Affiliations Gunasagran Y 0009-0003-7618-5603 [email protected] Universiti Malaya View all articles by this author Jones C P Cardiff University School of Medicine View all articles by this author Naskretski A NHS Wales Cardiff and Vale University Health Board View all articles by this author Sinha A NHS Wales Cardiff and Vale University Health Board View all articles by this author Kenneth Lim NHS Wales Cardiff and Vale University Health Board View all articles by this author Howells R NHS Wales Cardiff and Vale University Health Board View all articles by this author Rzyska E NHS Wales Cardiff and Vale University Health Board View all articles by this author Aarti Sharma NHS Wales Cardiff and Vale University Health Board View all articles by this author Metrics & Citations Metrics Article Usage 360 views 279 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Gunasagran Y, Jones C P, Naskretski A, et al. 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