What Is Pap Smear Test In Pregnancy And How Does It Work?

A safe and routine prenatal test to identify abnormal cervical cells.

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Pap smear test in pregnancy is usually done on the first prenatal visit to look for any changes in the cervical cells. Routine antenatal visits provide an opportunity to screen and raise awareness of cervical cancer, a leading cause of death in women of reproductive age.

According to the American Cancer Society (ACS), women of reproductive age should get a pap smear test every three years and a pap smear plus HPV (human papillomavirus) DNA test every five years since HPV is the most common cause of cervical cancer. Sampling cervical cells in these intervals helps identify any abnormalities in the early stages (1).

Read on to know when and how the Pap smear test in pregnancy is performed.

Who Needs Pap Smear During Pregnancy?

Your doctor may recommend taking a test during your first antenatal appointment in the following cases (2):

  • If you have a history of abnormal pap smears
  • If you haven’t had a screening test in the last three to five years
  • If you are taking immunosuppressant medicines (3)
  • If you have a weakened immune system due to conditions such as HIV (3)

Otherwise, a pap smear test can be postponed until four months after your childbirth if you are pregnant and due for one.

Is A Pap Smear Test Safe During Pregnancy?

A pap smear test is suggested as a routine test for prenatal care (3) and is completely safe for the mother and the fetus. It can be carried out at any time during pregnancy, provided the correct equipment is used.

However, it is usually suggested during the first prenatal visit (3) as a part of a physical exam to rule out squamous intraepithelial lesions (SIL) and cervical or vaginal infection, all of which pose a threat to the mother and fetus (4).

Various concerns state performing a pap smear test while being pregnant can cause miscarriage; however, there is no medical evidence to support it. In some cases, you may experience light bleeding or spotting during sample collection which is normal and poses no risk to the mother or fetus (5).

While any bleeding while pregnant is concerning, in this case, it is from the cervix rather than from the uterus, where the baby is safe and developing (5).

Why Are Pap Smears Done During Pregnancy?

The pap smear test detects the presence or absence of abnormal cells (cancerous or precancerous cells). It is advised for all women over the age of 21; however, in many countries, regular antenatal visits provide an opportunity to screen the cervix for neoplastic and infectious disorders to raise awareness regarding the importance of pap tests. It also detects and treats infections that may affect the pregnancy’s outcome (1) (3).

Pap smear test may diagnose precancerous lesions or it can reveal abnormalities in your cervix that aren’t visible to the naked eye, allowing further testing or investigation (3).

How Is A Pap Smear Test Done During Pregnancy?

A pap smear test is usually conducted during pregnancy and a pelvic exam during the first antenatal appointment. Your physician will offer you a patient information leaflet about the test and a consent form before the procedure. Once you’ve given your consent, the doctor will either set a date for the procedure or do the test straight away.

Preparation for a pap smear test is not necessary; however, there are some criteria where a pregnant woman can be excluded from taking a pap smear test (1). Steps to obtain the pap smear using a conventional procedure include (1) (4):

  • Taking off all clothing below the waist and putting on or covering up with a hospital gown (6).
  • After emptying the bladder, position yourself in a dorsal or lithotomy position.
  • The first sample will be obtained from the ectocervix using an Ayres spatula after a plastic tool (Cusco’s speculum) is inserted into your vagina to stretch its walls apart to reveal the cervix.
  • The Ayers spatula is then positioned at the cervical os with the longer end inside the cervical canal and the shorter end resting on the ectocervix. The spatula is then rotated by 360° while remaining in contact with the ectocervix.
  • After obtaining the sample, the spatula (both sides) is smeared on the slide and quickly fixed with a fixative.
  • The endocervix is then sampled with a cytobrush, smeared on a slide, and fixed in the same way.
  • Both samples of ectocervix or endocervix are dipped to a liquid for thin-prep test.
  • While sending the collected samples to the cytology laboratory, the patient’s information is written on the slides along with the requisition form.

What Do ThePap Smear Test Results Mean?

Pap smear test results can take up to three weeks and could interpret any of the following:

  1. Negative: A negative pap smear result indicates your cervix is normal and has no abnormal cells (i.e., cancerous or precancerous cells). Your physician may also advise you to take the test again after three years if only a pap test was done and after five years if you had a pap test along with an HPV test (7).
  1. Positive: A positive pap smear test result reveals abnormal cells in your cervix, but it does not indicate cervical cancer or dysplasia. The modified Bethesda classification (2014) can be used to report these cytological abnormalities (1). If your pap result is abnormal, your doctor may refer you to an oncologist or a gynecologic oncologist for further testing (colposcopy or a biopsy). These tests determine if you have an infection, inflammation, yeast infection, trichomonas, herpes, or HPV (3) to initiate a treatment accordingly (2).
  1. Unclear: In some cases, the results may appear unclear as various physiologic changes associated with pregnancy can make interpreting a pap smear challenging. Increased levels of estrogen and progesterone, for instance, cause hyperplasia of the cervical glands, resulting in a mucus plug. Due to the thickening and tenacity of endocervical mucus during pregnancy, and an increase in vaginal secretions, cervix visibility may be hindered. In such cases, the Pap test can be performed again in four months (4).

Frequently Asked Questions

1. Is a pap smear painful during pregnancy?

A pap smear during pregnancy is not harmful, but you may feel uncomfortable and experience spotting after the test (3).

2. In which week of pregnancy do I get a pap smear?

Your obstetrician will recommend a pap smear test during your first prenatal visit as part of routine prenatal testing (3). However, if there is a delay, ensure the test is done within the first 24 weeks of pregnancy because the procedure may be painful later (8).

3. Will a pap test harm my baby?

No. A pap smear test is completely safe for you and your unborn baby. The spotting after the test is not harmful to the baby because the blood flows from outside the cervix rather than inside the uterus (5). Additionally, even if you have abnormal test results, it is unlikely your baby will be affected because it is extremely rare for it to progress into cancer during pregnancy (9).

The pap smear test for cervical cancer screening is advised for all women over 21 in several countries. It does not require any preparation and can be done during the first antenatal visit or at any point during the pregnancy when needed. A positive pap test indicates the presence of abnormal cells but does not prove that you have cervical cancer. Rather, it suggests further testing and examinations. A Pap test is safe in pregnant women and may cause spotting (or minor bleeding) in rare cases.

Key Pointers

  • A doctor may suggest a pap smear test for pregnant women if they have weak immune systems or a history of abnormal pap smear results.
  • It is a safe procedure for the mother and fetus.
  • The procedure takes a few minutes and is only conducted after recieveing consent from the pregnant woman.
  • The results may be positive, negative, or unclear based on the presence or absence of abnormal cells in the cervix.

References

  1. Ahuja R, Sharma P, and Chawla R. Pap smear in antenatal women: a valuable opportunity for screening and awareness.
    https://www.msjonline.org/index.php/ijrms/article/view/7965/5553
  2. Pregnancy and abnormal cervical cells.
    https://www.cancerresearchuk.org/about-cancer/cervical-cancer/treatment-for-abnormal-cervical-cells/pregnancy
  3. Pap Smears During Pregnancy.
    https://americanpregnancy.org/womens-health/pap-smear/
  4. Priya SS, Shankar R. PAP smear in pregnancy: a hospital-based study.
    https://www.ijrcog.org/index.php/ijrcog/article/view/5630/4063
  5. Awosemusi Y. Pap smears are safe – before, during and after pregnancy.
    https://utswmed.org/medblog/pap-smear-safety-pregnancy/
  6. Pap Test.
    https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pap-test
  7. Next Steps after an Abnormal Cervical Cancer Screening Test: Understanding HPV and Pap Test Results.
    https://www.cancer.gov/types/cervical/understanding-abnormal-hpv-and-pap-test-results
  8. Pap Smear Test: 5 Things To Know Before You Go For Your First Pap Smear Test.
    https://www.kimshealth.org/trivandrum/blog/pap-smear-test-5-things-know-you-go-your-first-pap-smear-test/
  9. Cervical screening during pregnancy.
    https://www.pregnancybirthbaby.org.au/cervical-screening-during-pregnancy
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