Risk Factors for Abnormal Cervical Cytology in Pregnant Women Attending the High-Risk Obstetrics Clinic at the University Hospital in San Juan, Puerto Rico‪.‬

Carcinoma of the cervix uteri is the third most common gynecologic cancer in the United States, with an incidence rate of 8.2/100,000 (1). In Puerto Rico, it is 5th most common cancer in women, and its incidence is higher at 10.3/100,000 (2). Previous studies have shown that Hispanic women have a greater propensity for developing invasive cervical cancer (3). This might be related to the fact that they are generally less adherent to screening when compared to white women (4-5). The American College of Obstetricians and Gynecologists, the US Preventive Services Task Force (USPSTF), and the American Cancer Society recommend screening in sexually active women at least every 3 years, starting at age 21 or 3 years after the first coitus (6-8). Approximately 30% of women diagnosed with cervical cancer are in their childbearing years, and 5-8% of pregnant women seeking prenatal care are found to have an abnormal Papanicolaou smear (9-10). The management of abnormal cytology during pregnancy can be challenging. Further diagnostic studies, such as colposcopy and cervical biopsy, although not contraindicated in pregnancy, are usually deferred until the postpartum period in a patient with atypical squamous cells of unknown significance (ASCUS) or low-grade squamous intraepithelial lesion (LGSIL) (11). High-grade lesions, however, necessitate a colposcopic evaluation and cervical biopsy (11). If invasive cancer is found, treatment will depend on tumor staging, patient's age, gestational age, parity, and her desire to continue the present pregnancy (12).