Sharon Bond, CNM, MSN, is a faculty member in the Nurse-Midwifery Education program at the Medical University of South Carolina, Charleston, SC. She has an active practice that includes the management of women with abnormal Pap tests. She is currently a doctoral candidate conducting research on attitudes and beliefs about human papillomavirus vaccines.
Caring for Women With Abnormal Papanicolaou Tests During Pregnancy
Article first published online: 24 DEC 2010
2009 American College of Nurse Midwives
Journal of Midwifery & Womens Health
Volume 54, Issue 3, pages 201–210, May-June 2009
How to Cite
Bond, S. (2009), Caring for Women With Abnormal Papanicolaou Tests During Pregnancy. Journal of Midwifery & Womens Health, 54: 201–210. doi: 10.1016/j.jmwh.2009.01.004
- Issue published online: 24 DEC 2010
- Article first published online: 24 DEC 2010
- cervical cancer screening;
- cervical intraepithelial neoplasia;
- squamous cell cancer
The Papanicolaou (Pap) test is one of the best screening tests available for cancer detection and has achieved widespread acceptance among women. Pregnancy provides a valuable opportunity to educate and screen women for cervical cancer when receiving prenatal care. However, evolving knowledge about the course of human papillomavirus infection (HPV) in women, new technologies, and the advent of vaccines are driving radical changes in practice and new ways to consider cervical cancer screening. Modifications in the 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests are most evident among adolescents. Because of high rates of HPV regression, pregnant adolescents with minor Pap abnormalities may now be followed rather than referred for immediate colposcopy. Postponing colposcopy in pregnant, reproductive-age women with minor Pap changes until after delivery is now acceptable. Pregnant immunocompromised women with abnormal Pap tests are followed similarly to pregnant women in the general population. While a strong evidence base is gradually emerging to support guideline revisions, the highest quality evidence may not yet be available for all recommendations. Midwives can keep abreast of the science while using clinical judgment to provide safe and expert cancer screening care to women.