Interpretation of Pap smear in pregnancy is difficult to physiological changes [17]. In many countries where there is no regular screening, pregnancy may offer the woman a chance of screening during pregnancy. Abnormal smears should be followed up with colposcopy in pregnancy, and a directed biopsy must be taken. Endocervical curettage is contraindicated during pregnancy. The most common complication during colposcopic-directed biopsy is bleeding. Bleeding can be tackled with pressure, packing or rarely ligation of vessels. The risk of progression of CIN to invasive disease in pregnancy is low. The treatment of preinvasive lesions can be postponed after delivery. If there is microinvasive lesion, a cone biopsy or LEEP must be undertaken. The risk of bleeding PROM and preterm labour is more in higher gestational age than in lower gestational age [18, 19]. Cerclage of the cervix after LEEP or cone biopsy can be done to prevent preterm labour. If the pregnancy is close to maturity, LEEP or cone biopsy may be deferred till foetal maturity is achieved.

Surgery, neoadjuvant chemotherapy followed by surgery and chemoradiation are treatment available for carcinoma cervix. Seventy per cent of cancer cervix presents at stage 1 in pregnancy. Cervical cancer in pregnancy presents with bleeding, and it is important for physicians to remember that nonpregnancy-related causes can also present with bleeding in pregnancy. Pregnancy changes can underestimate the parametrial involvement. Pregnancy does not alter the prognosis in cervical cancer. A policy of termination of pregnancy and treatment of carcinoma of the cervix was advocated before. But currently the management has changed. Since pregnancy makes clinical staging difficult, MRI is used to stage the disease in pregnancy. MRI is the best modality to stage the disease [20]. However, MRI may not detect all enlarged nodes, and the best way to assess nodes is through lymphadenectomy and histopathological examination. Laparoscopic lymphadenectomy has been successfully used in pregnancy [21]. The management of carcinoma depends on the stage of the disease, lymph node metastasis and period of gestation. For stage IA1 squamous cell carcinoma, cone biopsy with preservation of the foetus can be safely performed between 14 and 20th week of pregnancy. In early-stage carcinoma of the cervix (< stage 1 B), the current policy is to do laparoscopic lymphadenectomy after MRI is used for staging [22, 23]. If the lymph nodes are negative, chemoradiation or definite surgery is done after delivery. In later-stage disease (> stage 1b) or if lymph nodes are involved, neoadjuvant chemotherapy is used and patient is delivered when foetal maturity is obtained. Most studies have used cisplatin for neoadjuvant therapy as weekly dose every 3 weeks [24]. No significant foetal effects have been observed. Definitive therapy can be undertaken once the patient is delivered.

If the patient presents in pregnancy and the patient is not keen, continuation of pregnancy chemoradiation can be started. Patient usually aborts in 3 weeks. If the patient is close to term, caesarean delivery followed by chemoradiation can be undertaken. Radical hysterectomy can be done along with caesarean section in early-stage disease.