Cervical smear at antenatal booking in HUSM : is it worthwhile?
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Date
2001-05
Authors
Syed Zainol Abidin, Sharifah Sofiah
Journal Title
Journal ISSN
Volume Title
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.
Description
Keywords
Cytological cervical smear