High-grade squamous intraepithelial lesions of the cervix (HSIL) during pregnancy: course and outcomes depending on the method of delivery

Objective. To study the natural course of squamous intraepithelial lesions (high-grade squamous intraepithelial lesions — HSIL) of the cervix of a high degree during pregnancy and the effect of the method of delivery on the outcomes of this disease. Data about the effects of pregnancy on HSIL changes remain limited and contradictory. Material and methods. The data of 65 pregnant women with HSIL were retrospectively analyzed (median age — 30.7 years, median gestation period — 15 weeks). The diagnosis was confirmed by biopsy, excision procedures were not performed during pregnancy. The monitoring included regular cytological monitoring. Among 65 patients, 44 gave birth naturally, 21 by caesarean section. After delivery, conization (23), cervical amputation (20), hysterectomy (2), cervical ablation (6), or follow-up (14) were performed. Results. Postpartum regression of HSIL was noted in 21.5% of cases (in 14 out of 65), persistence — in 78.5% (in 51 out of 65). Further progression to invasive cancer was recorded in 4.6% (in 3 out of 65). The regression rate after natural childbirth was 27.3% versus 9.5% after cesarean section (p=0.122). Conclusion. The method of delivery has no statistically significant effect on the outcome of HSIL (p=0.122). However, the high frequency of persistence (78.5%) and the risk of progression (4.6%) emphasize the need for mandatory postpartum follow-up and excision procedures if indicated.