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Old 05-12-2012
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ObGyn HSIL in pregnant female...expln plz

A 23-year-old G 1 PO female presents for her first prenatal visit at 14 weeks gestation. A pap smear is done at
that time and a high grade squamous intraepitheliallesions (HSIL) is seen at cytology. A test for HPV
discloses the presence of a strain with high oncogenic risk. A satisfactory colposcopy is done and shows no
site of abnormalities. At this time the next best step is:
A. Loop electrosurgical excision procedure (LEEP)
B. Repeat pap smear 12 months
C. Termination of pregnancy
D. Repeat colposcopy after delivery
E. Endocervical curettage
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Old 05-12-2012
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as far as i know pregnant women dont differ in mgm from non-preg except for NO endocervical curttage
this women is (+) for onco-hpv strain & nothing on colposcopy --> here we cant proceed with ECC or cone biopsy to look for endocervical lesion and since ectocervial lesion are ruled out, i think the best mgm is to repeat colpo after delivery with ECC
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Old 05-12-2012
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Pregnant women with HSIL should undergo colposcopy with biopsies of all lesions suspicious of CIN 2,3 or worse. Diagnostic excisional procedures and endocervical curettage are avoided due to the risk of disrupting the pregnancy

We perform postpartum cytologic and colposcopic evaluation on all women with HSIL diagnosed during pregnancy, but defer these examinations until at least six weeks post-delivery to allow the cervix to resume its nonpregnant state.
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