Oncologic and pregnancy outcomes of cervical high-grade intraepithelial lesions and delivery mode

Objective: To evaluate the natural progression of high-grade squamous intraepithelial lesions (HSIL) during pregnancy and assess the impact of delivery mode (vaginal vs. cesarean) on regression, persistence, and progression outcomes. Materials and methods: A retrospective cohort study analyzed 65 pregnant women with histologically confirmed HSIL (2007–2022). Exclusion criteria included excisional procedures during pregnancy or preterm delivery. Patients underwent antenatal colposcopy/cytology every 6–8 weeks, with postpartum reassessment at 8 weeks. Outcomes were categorized as regression (cervical intraepithelial neoplasia (CIN) grade reduction/absence), persistence (unchanged HSIL), or progression (increased severity). Statistical analysis used Fisher’s exact test (significance: p < 0.05). Results: Regression: value of 21.5% (14/65), numerically higher after vaginal delivery (27.3% vs. 9.5% cesarean; p = 0.122). Persistence: value of 78.5% (51/65), with 90.5% post-cesarean vs. 72.7% vaginal (p = 0.09). Progression to cancer: 4.6% (3/65), exclusively in persistent cases. Treatments: overall, 69.4% of patients required excisional procedures postpartum. Conclusions: Delivery mode did not significantly affect HSIL regression (p = 0.122), supporting delivery decisions based on obstetric indications alone. High persistence rates (78.5%) necessitate rigorous postpartum surveillance.