COMPREHENSIVE ASSESSMENT OF CERVICAL MUCOSA DURING PREGNANCY
DOI:
https://doi.org/10.11603/24116-4944.2017.1.7494Keywords:
cervix, pregnancy, colposcopy, cytology.Abstract
The aim of the study – to analyze the results of a comprehensive assessment of the cervix in healthy women during pregnancy.
Materials and Methods. 76 healthy women registered for pregnancy without cervical lesions (age from 23 to 35 years) were observed. The control group consisted of 30 healthy non-pregnant women of reproductive age. In addition to general clinical examination colposcopic, cytological and microbiological studies were conducted, the level of local immunity (immunoglobulin (Ig) class A, M, G and sIgA) were measured in I, II and III trimesters of pregnancy.
Results and Discussion. The study proved that during pregnancy there are physiological changes in cervical mucosa. During colposcopy increased vascularization (14.5 %), epithelial edema (14.5 %), epithelial junction off set towards ectocervix (15.8 %), deciduosis (7.9 %), dumb iodine-negative zones (in 15.8 % from the second trimester) were found. The frequency of these changes was increased with the course of pregnancy. Cytological study revealed the presence of cytolysis cells, prevalence of intermediate cell layers, signs of inflammation (14.5 %) and hyperkeratosis (10.5 % from the second trimester). The frequency of these events increased up to the third trimester. The study of local immunity parameters revealed marked increase of IgA (48.2 ± 0.92 g/L) and sIgA (16.7 ± 0.73 g/L) in vaginal-cervical flushing in the third trimester compared to the first and second trimesters (p <0.05), indicating an increase in the protective properties of cervical mucosa before delivery. When the cervical mucosa was studied during pregnancy, mild cervical dysplasia was detected in the third trimester in 1 (1.3 %) patients with colposcopy and in 2 (2.6 %) with cytology.
Conclusions. A comprehensive assessment of the cervical mucosa in women with unchanged cervix showed that during pregnancy there are changes related to gestational remodelling influenced by hormonal, metabolic and immunological processes which are inherent to physiological pregnancy. Performance and correct interpretation of colposcopic, cytological, immunological screening results in pregnancy to exclude suspected precancerous and malignant cervical processes allows to detect the pathological process timely and to provide adequate treatment.
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