Cervical cytopathological changes in pregnancy: An experience from a low resource setting.
Background
Cervical cancer is the leading cause of death among women in developing countries. It is preventable through effective cervical cancer screening program. However, in Nigeria, screening programs are opportunistic and coverage is insufficient to make an impact.


Aim
This study assessed the cervical cytopathological changes among pregnant women at booking using liquid-based cytology (LBC) in Aminu Kano Teaching Hospital (AKTH).


Methodology
This was a cross-sectional study that was carried out at the antenatal Clinic of AKTH, Kano, Nigeria. A total of 161 pregnant women who fulfilled the criteria and gave their consent were recruited into the study using systematic sampling technique at booking for antenatal care. LBC was employed using standard procedure and samples sent to histopathology department for analysis. Pro forma developed for the study was used to obtain the socio-demographic and reproductive characteristics of the women and the risk factors for abnormal cervical cytology.


Results
Out of the 161 pregnant women that had cervical cytology screening using LBC on their first prenatal visit during the study, 22 had abnormal cervical cytology, giving a prevalence rate of 13.7%. Out of this, six (27.3%) were atypical squamous cells of undetermined significance, 3 (13.6%) were Atypical Squamous Cells, Cannot Rule Out HSIL (ASC-H), 11 (50.0%) were low-grade Squamous Intraepithelial Lesions while 2 (9.1%) were high grade squamous intraepithelial lesions. Negative smears were seen in 104 women (64.6%). Inflammatory and other conditions of the cervix which are technically negative smears made up the remaining 21.7%. There was a statistically significant association between cervical cytology results and advanced age (P < 0.01), increasing number of lifetime sexual partners since coitarche (P < 0.01), high parity (P < 0.01), absent previous Pap test (P < 0.027), previous history of sexually transmitted infections (P < 0.040), and positive HIV status (P < 0.001). Following binary logistic regression, advanced maternal age, increasing number of sexual partners, high parity, and positive HIV status stood out to be independent predictors of premalignant lesions of the cervix in pregnancy in this study.


Conclusion
Advanced maternal age, increasing number of sexual partners, high parity, and positive HIV status stood out to be independent predictors of premalignant lesions of the cervix in the study. Routine cervical cytology screening using LBC should be offered to all antenatal clients in our setting to increase coverage and detection rate of preinvasive lesions of the cervix, and/or pregnant women with increased risk of abnormal cervical cytology from this study.
['Rasheed|Fatima Abubakar|FA|', 'Yakasai|Ibrahim Adamu|IA|', 'Takai|Idris Usman|IU|', 'Yusuf|Ibrahim|I|', 'Ibrahim|Usman Muhammad|UM|']
D000328:Adult D065309:Atypical Squamous Cells of the Cervix D018290:Cervical Intraepithelial Neoplasia D002584:Cervix Uteri D003430:Cross-Sectional Studies D003581:Cytodiagnosis D055088:Early Detection of Cancer D005260:Female D006801:Humans D008403:Mass Screening D008423:Maternal Age D009549:Nigeria D011247:Pregnancy D012307:Risk Factors D012959:Socioeconomic Factors D002583:Uterine Cervical Neoplasms
cervical cytopathological changes pregnancy liquid-based cytology Cervical cytology preinvasive cervical lesions