THE EFFECTIVENESS AND SAFETY OF 2 CERVICAL CYTOLOGIC TECHNIQUES DURING PREGNANCY

BACKGROUND. There have been few studies documenting the optimal cervic al cytologic technique in pregnancy. This study was initiated to inves tigate the effectiveness and safety of two standard techniques. METHOD S. Two hundred twenty-two new obstetrical patients at a family practic e residency program signed informed consent, were enrolled, and were r andomized for cervical cytologic screening using either Zelsmyr Cytobr ush and Ayre spatula or Dacron swab and Ayre spatula. The pathologists were blinded to the study, and results were reported with standard Be thesda System nomenclature. Patients were asked about complications at follow-up visits. Statistical analysis was performed using Fisher's e xact test and the two-sample t test, with statistical significance set at P <.05. RESULTS. The Cytobrush-spatula technique yielded 95.6% (10 8/113) smears with adequate endocervical cells, as compared with 69.7% (76/109) of smears obtained with the Dacron swab and spatula (P = <.0 001, odds ratio 9.38). Cytologic atypia, defined as noninflammatory ce llular abnormalities, was uncovered on 15.9% (18/113) of the smears ob tained with the Cytobrush and spatula tecnique and on 13.8% (15/109) o f the smears obtained with the Dacron swab and spatula (P =.7082). The complication rate, which included spot bleeding and spontaneous abort ion, occurred in 6.5% (7/108) of the smears obtained with the Cytobrus h and 3.8% (4/105) of the smears obtained with the Dacron swab (P =.54 ). CONCLUSIONS. The Cytobrush-spatula technique significantly increase d endocervical cell yield, did not increase detection of cytologic aty pia, and did not increase the risk of adverse maternal or fetal outcom es when used for cervical cytologic screening during pregnancy. These results support the use of the Cytobrush-spatula technique over the sw ab and spatula for obtaining cervical cytologic smears in pregnancy.