Screening for cervical neoplasia during pregnancy

Objective: To evaluate cytology as a screening method for cervical neoplasia in pregnancy and to compare it with cervicography and the acetic acid test (AAT). Methods: In a large antenatal clinic in South Africa, 842 women were screened utilizing cytology, cervicography and the acetic acid test simultaneously. The proportion of positive results of the different tests were compared and the agreement calculated by the kappa statistic. Results: The mean age of the women was 27 years, and 12.5% smoked. Cytological smears were abnormal (low-grade squamous intra-epithelial lesion and higher degrees of abnormality) in 1.4% of cases, cervicography in 6.3% and the AAT in 14.3% (P = 0.5400). Kappa values were as follows: cytology vs, cervicography 0.01, cytology vs. AAT 0.0 and cervicography vs. AAT 0.2. Conclusions: As a result of cytology's rather low yield and the small measure of agreement between the tests, cytology should be supplemented by an additional screening test in pregnancy. (C) 2000 International Federation of Gynecology and Obstetrics.