Why do a Pap during pregnancy?

[day-by-day]

I'm totally planning to refuse the Pap during my first prenatal visit, but my question is, why do they do them at all during pregnancy? My midwife told me that pregnancy hormones can cause changes to the cervical cells (just like semen can if you've had sex within 48 hours of having the Pap done.) Why do it routinely if you know the results could be skewed by the fact that you are pregnant? It doesn't make sense to me.

[blessedNjoyful]

I've always had the Pap done at my 6 week postpartum visit. Besides the possibility of skewed results that you mentioned there's also the possibility of causing of miscarriage. It's just not worth it to me.

[paintedfire]

I have no idea. Money, maybe?

[EMandM]

I think it may be just to make sure it gets done since alot of women don't keep up with having it done outside of pregnancy.

[MeepyCat]

Originally Posted by blessedNjoyful

I've always had the Pap done at my 6 week postpartum visit. Besides the possibility of skewed results that you mentioned there's also the possibility of causing of miscarriage. It's just not worth it to me.

??? I don't know where you're getting the stuff about pap smears possibly causing miscarriages.

An active case of HPV can cause complications in delivery (depending on size and location of genital warts). I don't know how helpful pap smears are in detecting these problems vs. ordinary visual pelvic exams. But pap smears are not associated with increased risk of miscarriage.

[wytchywoman]

I've always been told that aside from the pap that they were testing for STD's. Some things can be transmitted during birth and some can cause in utero birth defects, so I think they were looking for problematic areas up front.

[katelove]

Probably opportunistic screening. As a PP said, women may not be having them routinely so while they are seeing their HCP they take the opportunity to do one.

They are not routinely done during pregnancy in Australia. We ask when the woman last had one and, if it is due sometime during the pregnancy, then we advise her to have one at the 6 week postnatal visit.

[Lit Chick]

No idea. My MW does not do ANY exams of that nature unless I wanted them - the first time my pants come off, I'm about to push a baby out.

[angelpie545]

I'm imagine it's become routine because they like to do STD screening at the same time, so if you're there, why not I guess? I don't personally think it's necessary if you're up to date on them. I can see why they'd want do a PAP the patient hasn't had one in awhile.

[kalamos23]

Originally Posted by MeepyCat

??? I don't know where you're getting the stuff about pap smears possibly causing miscarriages.

An active case of HPV can cause complications in delivery (depending on size and location of genital warts). I don't know how helpful pap smears are in detecting these problems vs. ordinary visual pelvic exams. But pap smears are not associated with increased risk of miscarriage.

Ok - if they put women on pelvic rest (no DTD, no vacuuming, nothing in your vagina) so women won't miscarry, then I don't see how a pap, which is scraping cells off your cervix, could not have ANY increased risk of miscarriage.

Honestly, just google pap smear miscarriage risk. There are enough women on forums that have had m/c with 36 hours of a pap smear for me to feel uneasy with them during pregnancy.

[~Adorkable~]

I do not believe that there is a increased ms risk, I would say that anything that seem to happen before a miscarriage that was probably going to happen anyway is usually blamed.

I think most OBs do them because most ladies haven't had one in a while. I asked my ob when she wanted to do one at my 10 week appointment, so i asked her what she could learn that she could even a dress while I was preggo, she kinda mumbled and didn't really have a clear response other that it was routine, so I declined and told her I would get one at a post partum visit.
I did get the STD test (even though I knew I was clean) since they are not scrapping anything and having a clean bill of health on record will make it easier to not get my baby fussed with around birth.
I don't have any real issue with a limited number of vaginal exams, I just don't want scraping that made me hurt or cramp

( I guess cramping could trigger a miscarriage that was in the edge. But I really do not think it would be the main cause and I also thing that the miscarriage that would be triggered by a pap would also be triggered by sex or a strong cough as well and was just bound to happen)

[Twinklefae]

It's just because they've got you there - many many women do not get Pap's when they should. Also, they don't use the typical tool (the one that looks like a mascara brush) when you are pregnant. They use something that looks like a popsicle stick - specfically to avoid disrupting anything.

Also, they DON'T put women in their first trimester on pelvic rest. That doesn't happen until later on, typically. And here they don't do a pap much past 12 weeks.

[finnegansmom]

What if you were due for one?

I was due for a Pap in Feb, but had a 13 week MC with a D&E the beginning of that month, and having a pap was the last thing on my mind. A few months went by and I scheduled one for July, which was the earliest I could get in. Lo and behold, I'm now almost 8 weeks pregnant.
I'm 38 yo, I HAVE had abnormal paps before.
If I don't get it now, then we're talking 2+ years in between paps.

My mc was due to chromosomal issues - nothing cervix related or anything.

Would you get one? My gut says to, but coming on here and reading people saying they cause miscarriages is stressful.

[lillymonster]

Yes they used the stick on me. I got mine done because I hadn't been to an ob in over 2 years. I think I got one before DD turned a year, and she is 3 now.

I have never heard of no vacuuming/no sex in early pregnancy, I need to pass that along to DH! My sister had bedrest, but she was 7 months and having early labor.

[VillageMom6]

Many years ago I had my regular Pap in December (results were normal) and one in September, when I became pregnant. It was just part of the midwife's routine first appointment tests.

Even though the December Pap was normal, the September Pap came back with high-grade abnormalities. A follow-up Pap and a colposcopy confirmed those results.

Had I not been pregnant, they would have done a cervical cone biopsy immediately but that is definitely not an option during pregnancy. Instead I had a Pap done every trimester, to make sure that things weren't getting worse.

If it was progressing to cervical cancer, they would have wanted to deliver the baby as soon as it was safe. Thankfully nothing changed throughout my pregnancy and I was able to postpone surgery until I was three months postpartum.

Having gone from normal to high-grade abnormal within a few months, I've become a big promoter of those pesky Pap tests!

[MeepyCat]

Originally Posted by kalamos23

Ok - if they put women on pelvic rest (no DTD, no vacuuming, nothing in your vagina) so women won't miscarry, then I don't see how a pap, which is scraping cells off your cervix, could not have ANY increased risk of miscarriage.

But most women are not on pelvic rest during pregnancy, and the circumstances in which those activities are a risk to a pregnancy are uncommon. I had placenta previa with my most recent pregnancy, but received a pap smear at an initial visit with no problems.

I have googled pap smears and miscarriage. I haven't found good evidence, or even statistical correlations. And while I *did* begin to miscarry within 48 hours of having a pap smear in a previous pregnancy, I don't think that the miscarriage was caused by swabbing the outside of my cervix. Miscarriages are very common - something like 20% of confirmed pregnancies end in miscarriage - so inevitably, some women will begin to miscarry after receiving pap smears.

[kalamos23]

Originally Posted by Twinklefae

It's just because they've got you there - many many women do not get Pap's when they should. Also, they don't use the typical tool (the one that looks like a mascara brush) when you are pregnant. They use something that looks like a popsicle stick - specfically to avoid disrupting anything.

Also, they DON'T put women in their first trimester on pelvic rest. That doesn't happen until later on, typically. And here they don't do a pap much past 12 weeks.

They do put you on pelvic rest in the first tri - my OB put me on it in 2 different pregnancies for subchorionic hematomas.

Originally Posted by finnegansmom

What if you were due for one?

I was due for a Pap in Feb, but had a 13 week MC with a D&E the beginning of that month, and having a pap was the last thing on my mind. A few months went by and I scheduled one for July, which was the earliest I could get in. Lo and behold, I'm now almost 8 weeks pregnant.
I'm 38 yo, I HAVE had abnormal paps before.
If I don't get it now, then we're talking 2+ years in between paps.

My mc was due to chromosomal issues - nothing cervix related or anything.

Would you get one? My gut says to, but coming on here and reading people saying they cause miscarriages is stressful.

In your position, with abnormal paps, I would get one at 11w+ when the placenta is already taking over and not bat an eyelash - I'm more uneasy with them in early early pregnancy. I've had one at 12 weeks with DD though.

Originally Posted by MeepyCat

But most women are not on pelvic rest during pregnancy, and the circumstances in which those activities are a risk to a pregnancy are uncommon. I had placenta previa with my most recent pregnancy, but received a pap smear at an initial visit with no problems.

I have googled pap smears and miscarriage. I haven't found good evidence, or even statistical correlations. And while I *did* begin to miscarry within 48 hours of having a pap smear in a previous pregnancy, I don't think that the miscarriage was caused by swabbing the outside of my cervix. Miscarriages are very common - something like 20% of confirmed pregnancies end in miscarriage - so inevitably, some women will begin to miscarry after receiving pap smears.

Yeah, I couldn't find any studies (though I didn't google very hard), it's anecdotal. It just makes me uneasy enough to take precautions so that I don't have to have one in early pregnancy, know what I mean? I'm already on the bad side of the odds as far as pregnancies to live birth ratio goes - my last m/c, I was in the less than 2% group for miscarrying.

That being said, the longest I have gone without a pap is 1.5 years - due to moving and early pregnancy with DD - I have not had any abnormal paps, am monogamous and 27 so am considered low risk. If I was higher risk, I would still wait until the first tri was over, but have the pap.

I am in no way saying not to have paps during pregnancy or at all, just that I am wary of them in early pregnancy and the PP that said there was no risk at all of miscarriage, I don't think is accurate - there are risks to everything. I would guess that early on in pregnancy while the hormones are still driving the pregnancy, before the placenta takes over, the pregnancy would be the most vulnerable to messing around with the cervix and the fluctuations in hormones/cramps that it could cause.

[bella99]

But really, if the very mild disturbance to the cervix during a pap smear could be the cause of the miscarriage, then shouldn't pregnant women be abstaining from sex during the entire first trimester because of those same risks?

For sure, there are women who don't have sex during the first trimester, but is this really why?

Really, unless your doctor is horribly rough, I tend to highly doubt it could cause a miscarriage. Maybe it can hasten a miscarriage that was already on its way if the cervix was disturbed enough, but even then, I question.

[day-by-day]

But has anyone else heard anything about the possibility that pregnancy hormones can cause cervical cells to be abnormal? I guess my thinking is that, regardless of whether a Pap can cause a miscarriage, if it is more likely to produce a false positive result (cells that are abnormal but not tending toward cancer) and your practitioner is less likely to do anything other than observe during pregnancy and (as a previous poster suggested) abnormal cells are likely to be sloughed off during labor and delivery, then what is the good of doing them routinely during pregnancy at all? Why not simply recommend them at the 6 week post partum check up?

The risk of a Pap causing problems may be miniscule, but the benefit seems miniscule to me too? Why risk it?

[finnegansmom]

Originally Posted by day-by-day

But has anyone else heard anything about the possibility that pregnancy hormones can cause cervical cells to be abnormal? I guess my thinking is that, regardless of whether a Pap can cause a miscarriage, if it is more likely to produce a false positive result (cells that are abnormal but not tending toward cancer) and your practitioner is less likely to do anything other than observe during pregnancy and (as a previous poster suggested) abnormal cells are likely to be sloughed off during labor and delivery, then what is the good of doing them routinely during pregnancy at all? Why not simply recommend them at the 6 week post partum check up?

The risk of a Pap causing problems may be miniscule, but the benefit seems miniscule to me too? Why risk it?

When I was pregnant with #1 a million years ago it seems and totally uneducated, my OB did the routine pap at 10 or 12 weeks, something like that. The results came back ABNORMAL. Ugh, she told me, well we won't do anything about it now anyways, and since cells can be abnormal when pregnant and they just did a followup at 6 weeks pp which came back normal.

I don't know much if anything on how cells are graded. I've had a history or true abnormal/pre cancer cells. Are there steps, like "abnormal but not too bad", "abnormal about to be cancer" etc?