[1109] Prepartum Cervical Cytologic Changes Correlated with Abnormal Placental Changes and Preterm Delivery

Z Zuo, S Goel, JE Carter. University of South Alabama, Mobile, AL

Background: The understanding of clinical implications of abnormal cytology screening results in the pregnant population is incomplete. The objective of this study was to determine clinical implications of abnormal cervical cytologic screening on the outcome of pregnancy.
Design: A 12-year review of cases from our institution yielded 2480 cases with data for comparison of the impact of abnormal cervical cytology on placental changes and pregnancy outcome in terms of prematurity.
Results: Analysis showed a statistically significant correlation between reactive, inflammatory, infectious, atypical, and dysplastic prepartum cytologic changes with abnormal placental diagnoses including but not limited to accelerated/delayed placental maturation, various placental infections and vasculopathies (Table 1). All but dysplastic cytologic changes showed a statistically significant association with preterm labor (Table 1). Statistically significant associations were also present between a positive HPV DNA assay and preterm labor and abnormal placental diagnoses.

Table 1. Associations between Pap findings, placental findings, and pregnancy outcome

Pap Dx	N=2480	Abn P	p	OR(95% CI)	Preterm	p	OR(95% CI)
NORMAL	715	175	-	-	116	-	-
AGUS	29	16	<0.001	3.80(1.79-8.05)	11	<0.01	3.16(1.45-6.86)
ASCUS	290	133	<0.001	2.61(1.96-3.48)	66	<0.01	1.52(1.08-2.14)
HSIL	103	44	<0.001	2.30(1.50-3.52)	24	0.051	1.57(0.95-2.58)
LSIL	161	69	<0.001	2.31(1.62-3.30)	32	0.208	1.28(0.83-1.98)
REACTIVE	1182	482	<0.001	2.12(1.73-2.61)	278	<0.001	1.59(1.25-2.02)
Trichomonas	187	96	<0.001	3.26(2.33-4.54)	63	<0.001	2.62(1.83-3.77)
Candida	476	193	<0.001	2.10(1.64-2.70)	100	<0.01	1.37(1.02-1.85)

Notes: Pap Dx, Pap diagnosis during pregnancy. Abn P, cases of placenta with pathological findings. Differences between each Pap Dx to NORMAL analyzed using Chi square test, two-tailed p values are shown. Statistical significance defined as p<0.05. OR, odd ratio. 95% CI, 95% confidence interval.


Conclusions: These findings indicate that prepartum dysplastic cervical changes do not affect the duration of gestation or correlate with abnormal placental changes, but that the presence of infectious agents and inflammatory atypia on prepartum cervical screening may serve as a risk marker for preterm labor and abnormal placental changes.
Category: Gynecologic

Monday, March 9, 2009 9:30 AM

Poster Session I Stowell-Orbison/Autopsy Award # 167, Monday Morning