Screening for cervical neoplasia during pregnancy

Objective: To evaluate cytology as a screening method for cervical neoplasi a in pregnancy and to compare it with cervicography and the acetic acid tes t (AAT). Methods: In a large antenatal clinic in South Africa, 842 women we re screened utilizing cytology, cervicography and the acetic acid test simu ltaneously. 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 we re 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 r esult of cytology's rather low yield and the small measure of agreement bet ween the tests, cytology should be supplemented by an additional screening test in pregnancy. (C) 2000 International Federation of Gynecology and Obst etrics.