Cervical smear at antenatal booking in HUSM : is it worthwhile?

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Date
2001-05
Authors
Syed Zainol Abidin, Sharifah Sofiah
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Publisher
Universiti Sains Malaysia
Abstract
The study is aimed to determine the prevalence of abnormal cervical smear in pregnant women attending booking clinic at Hospital Universiti Sains Malaysia. Secondly, we aimed to determine the pregnancy-related physiologic changes associated with normal cytological cervical smear in the study population. Lastly, we planned to compare the cytological cervical smears between pregnant and non-pregnant women in Hospital Universiti Sains Malaysia. It is a prospective cross-sectional study, was carried out at the Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, Kelantan between July 1999 till June 2000. A total of 321 pregnant women agreed to participate after counseling and verbal consent was obtained. From 321 cervical smears collected, 310 (96.6%) were satisfactory smears and 11 (3.4%) were unsatisfactory. The detail results of satisfactory smear, normal smear were 55 (17.7%), non-specific inflammatory smear were 193 (62.3%), infection of Gardnerella were 4 (1.3%), Actinomyces infection was 1 (0.3%), Trichomonas vagina/is infection was 1 (0.3%), Candidiasis infection were 45 (14.5%), ASCUS were 5 (1.6%), AGUS were 3 (1.0%), LSIL (HPV & CIN I) were 3 (1.0%) and no HSIL or carcinoma. From the study, the pregnancy-related changes associated with normal cervical smears in the study population consist of 285 (91.9°/o) navicular cells, 308 (99.3o/o) Lactobacilli, 207 (66.8°/o) squamous metaplastic cells, 3 ( 1.0%) decidual cells and no trophoblastic cells or "Arias-stella" changes cells. Navicular cells and abundant lactobacilli are characteristic of pregnancy-related changes in the cervical smear that are commonly seen. Decidual cells, trophoblastic cells or "Arias-stella" cells are rarely seen In pregnancy. When comparing the cervical smear of pregnant women with the cervical smear of non-pregnant women, the results were statistically not significant at p-value <0.05 for normal smear, non-specific inflammatory smear, Gardnerella vagina/is infection, Actinomyces infection, Chlamydia infection, ASCUS, AGUS, LSIL, HSIL, Squamous cell carcinoma and adenocarcinoma of the cervix. The result was statistically significant at p-value <0.05 for candida infection. Candida infection is more prevalent in pregnant women. In non-pregnant population, we are able to detect more abnormal cervical smears such as LSIL (2.0%), HSIL (1.1 %), Squamous cell carcinoma (0.3%) and adenocarcinoma of the cervix (0.3%). This is probably because the samples are larger, a total of 831 cervical smears. We conclude that we are able to detect abnormal cervical smears, whether the smears are taken during pregnancy or non-pregnant state and larger samples are required in pregnant population to get statistically significant results. Physiological pregnancy-related changes that may be present in the cervical smears such as decidual cells, trophoblastic cells or "Arias-stella" changes cell which can mimic malignant cells are rarely seen in pregnant population and we can differentiate the cells with meticulous and expert interpretation of the smears by the cytopathologist.
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Keywords
Cytological cervical smear
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