Navigating the challenge of high-grade cervical lesions (CIN3) in pregnancy: a near miss

BMJ Case Rep. 2024 Dec 10;17(12):e261808. doi: 10.1136/bcr-2024-261808.

Abstract

In this case, a pregnant Indigenous woman presented with high-grade cervical lesions (high-grade squamous intraepithelial lesion (HSIL), cervical intraepithelial neoplasia grade 3 (CIN2-3) and was lost to follow-up for over 5 years, posing a unique management challenge. Despite higher regression rates in pregnant women, personalised care was crucial due to potential pregnancy-related intervention risks.This case underscores the complexities of managing high-grade cervical lesions in pregnancy and highlights the significant burden of cervical cancer within Aboriginal and Torres Strait Islander communities. It emphasises the urgent need for equitable screening access, patient-centred care and culturally sensitive education among vulnerable populations.Of particular note is the case's uniqueness, with the patient's CIN3 diagnosis persisting for over 5 years and spanning three pregnancies without definitive management. Post partum, a subsequent LLETZ revealed extensive HSIL (CIN3) involving ectocervical and endocervical margins. Due to margin involvement, the patient now requires ongoing surveillance, with continued risk of being lost to follow-up due to the factors described.

Keywords: Cervical cancer; Cervical screening; Ethnic studies; General practice / family medicine; Healthcare improvement and patient safety.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Colposcopy
  • Female
  • Humans
  • Lost to Follow-Up
  • Pregnancy
  • Pregnancy Complications, Neoplastic* / diagnosis
  • Pregnancy Complications, Neoplastic* / pathology
  • Pregnancy Complications, Neoplastic* / therapy
  • Uterine Cervical Dysplasia* / diagnosis
  • Uterine Cervical Dysplasia* / pathology
  • Uterine Cervical Neoplasms* / diagnosis
  • Uterine Cervical Neoplasms* / pathology