POSTPARTUM DÖNEMDE BAŞVURAN HASTALARA UYGULANAN SERVİKAL SİTOLOJİ (PAP SMEAR) VE/VEYA HPV TEST SONUÇLARININ ANALİZİ

Abstract

ABSTRACT Alpan D., The Analysis of the Results of Cervical Cytology (Pap Smear) Tests and/or HPV Test Applied to the Patients Admitted in the Postpartum Period, Hacettepe University Faculty of Medicine, Obstetrics and Gynecology Dissertation Thesis, Ankara 2022 Cervical cancer is the fourth most prevalent type of cancer among females. It ranks second in female cancer mortalities. Cervical cancer is the most diagnosed malignity in pregnancy, with an incidence of 0.8-1.5 cases per 10,000 deliveries. Cervical cancer and premalignant lesion screening programs are applied with cervical cytology (PAP smear) and/or HPV tests, which are an essential part of both our country's health policies and preventive health services in the world. The positive cytology (PAP Smear) ratio in a non-pregnant population is approximately 3% in general, but it can range between 1% and 9.7%. According to the literature, the prevalence of cervical intraepithelial neoplasia (CIN) in pregnant women is approximately 1%, and these results are similar to those of the non-pregnant population. The hormonal environment, which changes during pregnancy, (steroid increase) and immune response during pregnancy can support the presence or persistence of HPV infection. A systematic review of the literature revealed that the prevalence of HPV in pregnant women ranges from 5.5% to 65%. In a recent study on pregnant and non-pregnant women of the same age, Luo et al. discovered that while the HPV prevalence in non-pregnant women was 14.8%, it was higher in pregnant women at 24.2%. Premature ruptures of the membrane (PROM) of several HPVs were found to be associated with preeclampsia, fetal growth restriction, preterm delivery, and placental abnormalities in several populations. The cumulative evidence suggests that the possibility of HPV infection continuing during pregnancy and postnatal regression is high. Cervical cancer screening as an antepartum routine is not performed at our center. Cervical cancer screening is used for women who should have a smear or an HPV test when they come for a check-up in the postpartum sixth week. Therefore, the smear and HPV results of patients who came in for a postpartum checkup were examined retrospectively in our study. The number of patients who underwent the HPV test (n = 73) was lower than the number of patients who underwent the smear test. This situation is believed to be the result of the ASCCP/ ACS/ ASCP/ WHO/ Republic of Türkiye Ministry of Health's recommendations for the HPV test to be administered to individuals aged 30 or above. The mean age in our study was 29.5, supporting this argument. Examining the test results of the 1012 patients in the postpartum period who had smear tests, 98.1% of were negative, 0.6% were (n=6) ASCUS, and 0.4% were LSIL (n=4). When the HPV results were examined, it was found that 6.4% were negative and 0.8% (n=8) were positive. The following HPV types were found in the patients who tested positive for HPV: HPV type 16 in two patients, HPV type 53 in three patients, HPV type 54 in one patient, HPV type 59 in one patient, and HPV type 66 in one patient. Out of 1003 patients, %99 tested negative for smear, while 1% tested positive. Out of 73 patients, %89 tested negative for HPV, while 11% tested positive. When the results of our study were reviewed, no patients with HSIL cytology or cervical cancer were found. There are studies in the literature indicating that people with positive HPV tests and/or smear test results are more likely to experience adverse obstetric outcomes. However, in the present study, no relationship was found between infants' birth weight, live birth or stillbirth, the need for advanced life support during delivery, preterm labor, IUGR and macrosomic fetus rates, and the mothers' smear or HPV results. While the APGAR scores did not change according to the smear results, the APGAR3 score was found to be significantly higher in the HPV-negative patients compared to those who are HPV positive. This study, which identified no significant association between drug utilization features and HPV and/or smear results, and studies indicating that the incidence of permanent hrHPV infection increases in individuals with immunosuppression and/or using immunosuppressive drugs are inconsistent. No relationship was detected between the mother's internal diseases, immunosuppression status, and smear results. When HPV results were examined, neurologic diseases were found to be more common in HPVpositive patients. There is no difference in other diseases or immunosuppressive status based on HPV results. Studies comparing HPV and/or smear tests performed during both the antepartum and postpartum periods within the parameters of this study will advance the research. Keywords: Cervical Cancer, Cervical Cancer Screening, Colposcopy, HPV, Pap Smear, Postpartum Period, Pregnancy