Prevalence, risk factors and pregnancy outcomes of cervical cell abnormalities in the puerperium in a hyperendemic HIV setting.
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Date
2017
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Abstract
Objective
We investigated the impact of cervical cell abnormalities detected in the puerperium in association with HIV-1 infection on pregnancy outcomes.
Methods
A behavioural intervention RCT enrolled 1480 pregnant women (>18years) at a peri-urban primary health clinic in South Africa during May 2008-June 2010. A pap smear was performed 14weeks postpartum and sent to the local laboratory services for cytology. We performed a secondary data analysis of pregnancy outcomes, Pap smear results (cytology), HIV results and participant demography.
Results
564 women (38.1%; 95%CI35.7-40.1) were HIV-1 positive and 78(8.0%; 95%CI6.4-9.9) women tested positive for cervical cell abnormalities at the postpartum visit. Forty two (4.2%; 95%CI 3.1-5.6) women presented with LGSIL, and 7 (0.7%; 95%CI 0.3-1.4) with HGSIL. In an adjusted analysis, HIV-infected women were significantly more likely to test positive for LGSIL (p<0.001) and HGSIL (p=0.011). Premature birth, low-birth weight and non-live birth rates were similar among HIV-infected and uninfected women with abnormal cervical cytology. Low-birth weight was also significantly more common among HIV infected women with normal cervical cytology.
Conclusion HIV-infected pregnant women are more likely to be diagnosed with higher grades of squamous cell abnormalities. There is no evidence of an association between squamous cell abnormalities/HIV comorbidity and adverse pregnancy outcomes.
Synopsis
HIV-infected pregnant women are likely to present with higher grades of cervical cell abnormalities in the puerperium but without any evidence of adverse pregnancy outcomes.
Description
Masters Degree. University of KwaZulu-Natal, Durban.