Frequency of Abnormal Pap Smear Cytology in Women with Post-Coital Bleeding: Abnormal Pap Smear Cytology in Women with Post-Coital Bleeding

Saba  Khan; Varsha  Bai; Memoona  Rehman; Erum  Majid; Geeta  Dembra; Piria  Dembra; Khadija  Bano

doi:10.54393/pjhs.v3i05.96

Authors

Saba Khan Jinnah Postgraduate Medical Centre, Karachi
Varsha Bai Aga Khan University Hospital, Karachi
Memoona Rehman Jinnah Postgraduate Medical Centre, Karachi
Erum Majid Jinnah Postgraduate Medical Centre, Karachi
Geeta Dembra Sheikh Hamdan Bin Muhammad Talika Hospital, Khanpur and Consultant at Sachal Centre, Ghotki
Piria Dembra Jinnah Postgraduate Medical Centre, Karachi
Khadija Bano Head of Department of Obstetrics and Gynecology, Al-Tibri Hospital and Medical College

DOI:

https://doi.org/10.54393/pjhs.v3i05.96

Keywords:

cervical cancer, PAP smear, post-coital bleeding

Abstract

Risk of development of cervical carcinoma has been identified in patients with abnormal cytology on Pap smear. A long duration of prior to development of invasive cervical carcinoma is governed by a precancerous lesion. Consequently, screening and proper treatment reduces the overall risk of cervical carcinoma. Objective: Aim of study was to identify the frequency of abnormal cervical cytology detected by Papanicolaou smear in married child bearing female presenting with bleeding following coitus. Methods: A Descriptive, Cross-sectional study was carried from 15^th November 2021 to 31^st May 2022 in the Department of Obstetrics and Gynecology, Jinnah Post graduate Medical Centre, Karachi. A total of 218 females of reproductive age group (18-50 years) presenting with post-coital bleeding were included. Patients with previously histo pathological diagnosis, ablative or excisional treatment modalities of cervix and trauma to genital tract were excluded. All cases underwent Pap smear testing with standard technique by utilization of Ayre's spatula and were fixated with 95% ethanol on microscopic slides. Two specimens were prepared for each patient and were assessed for abnormalities. Results: Patients encountered were between 18 to 50 years with mean of 32.20 ± 7.80 years. Majority (139; 67.43%) of the patients were between 18 to 35 years. Mean parity was 3.53 ± 1.51. Mean BMI was 29.12 ± 2.37 kg/m2. Frequency of abnormal cervical cytology was found in 37 (16.97%). Conclusions: This study concluded that Pap smear is an easy, effective and a cheap method for detecting women with cervical pathology.

References

Wan YL, Edmondson RJ, Crosbie EJ. Intermenstrual and postcoital bleeding. Obstetrics, Gynaecology & Reproductive Medicine. 2015 Apr; 25(4):106-12.

Tarney CM and Han J. Postcoital bleeding: a review on etiology, diagnosis, and management. Obstetrics & Gynecology International Journal. 2014;192087. doi: 10.1155/2014/192087.

Abdelkrim M, Abedelnacer T, Abdelkrim S. Frequency of Significant Cervical Pathology in Women Attending a Teaching Gynaecological Service for Postcoital Bleeding with Normal Cytology. In International Journal of Gynecological Cancer.Two Commerce Sq, 2001 Market St, Philadelphia, Pa 19103 Usa: Lippincott Williams & Wilkins 2016 Sep.

Catarino R, Petignat P, Dongui G, Vassilakos P. Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices. World Journal of Clinical Oncology. 2015 Dec; 6(6):281-90. doi: 10.5306/wjco. v6. i6.281.

Maleki A, Ahmadnia E, Avazeh A, Mazloomzadeh S, Molaei B, Jalilvand A. Prevalence of Abnormal Papanicolaou Test Results and Related Factors among Women Living in Zanjan, Iran. Asian Pacific journal of cancer prevention. 2015; 16(16):6935-9. doi: 10.7314/apjcp.2015.16.16.6935.

Liu HL, Chen CM, Pai LW, Hwu YJ, Lee HM, Chung YC. Comorbidity profiles among women with postcoital bleeding: a nationwide health insurance database. Archives of Gynecology and Obstetrics. 2017 Apr; 295(4):935-941. doi: 10.1007/s00404-017-4327-7.

Cheraghi F, Jolodarian P, Masoumi K, Forouzan A, Jafari RM. Comparison Results of Pap Smear and Colposcopy and Histopathology in Women with Post-Coital Bleeding. Research Journal of Obstetrics and Gynecology. 2015 Jan; 8(1):10.

Gupta M, Sharma A, Agarwal N, Agarwal A. Clinical profile of women with postcoital bleeding. Santosh University Journal of Health Science. 2016; 2(2):106-8.

Getinet M, Gelaw B, Sisay A, Mahmoud EA, Assefa A. Prevalence and predictors of Pap smear cervical epithelial cell abnormality among HIV-positive and negative women attending gynecological examination in cervical cancer screening center at Debre Markos referral hospital, East Gojjam, Northwest Ethiopia. BMC Clinical Pathology. 2015 Sep; 15:16. doi: 10.1186/s12907-015-0016-2.

Kolawole O, Olatunji K, Durowade K, Adeniyi A, Omokanye L. Prevalence, risk factors of human papillomavirus infection and papanicolaou smear pattern among women attending a tertiary health facility in south-west Nigeria. TAF Preventive Medicine Bulletin. 2015 Nov; 14(6).

Duru CB, Oluoha RU, Uwakwe KA, Diwe KC, Merenu IA, Emerole CA, et al. Pattern of PAP smear test results among Nigerian women attending clinics in a teaching hospital. International journal of current microbiology and applied sciences. 2015; 4(4):986-98.

Bosetti C, Bravi F, Negri E, La Vecchia C. Oral contraceptives and colorectal cancer risk: a systematic review and meta-analysis. Human reproduction update. 2009 Sep; 15(5):489-98.

Pretorius R, Semrad N, Watring W, Fotheringham N. Presentation of cervical cancer. Gynecologic oncology. 1991 Jul; 42(1):48-53. doi: 10.1016/0090-8258(91)90229-x.

Pardanani NS, Tischler LP, Brown WH, Feo ED. Carcinoma of cervix. Evaluation of treatment in community hospital. New York State Journal of Medicine. 1975 Jun; 75(7):1018-21.

Slater DN. Multifactorial audit of invasive cervical cancer: key lessons for the National Screening Program. Journal of Clinical Pathology. 1995 May; 48(5):405-7. doi: 10.1136/jcp.48.5.405.

Rosenthal AN, Panoskaltsis T, Smith T, Soutter WP. The frequency of significant pathology in women attending a general gynecological service for postcoital bleeding. British journal of obstetrics and gynaecology. 2001 Jan; 108(1):103-6. doi: 10.1111/j.1471-0528.2001.00008. x.

Al Eyd GJ and Shaik RB. Rate of opportunistic pap smear screening and patterns of epithelial cell abnormalities in pap smears in ajman, United arab emirates. Sultan Qaboos University Medical Journal. 2012 Nov; 12(4):473-8. doi: 10.12816/0003173

Tehranian A, Rezaii N, Mohit M, Eslami B, Arab M, Asgari Z. Evaluation of women presenting with postcoital bleeding by cytology and colposcopy. International Journal of Gynecology and Obstetrics. 2009 Apr;105(1):18-20. doi: 10.1016/j.ijgo.2008.12.006.

Shalini R, Amita S, Neera MA. How alarming is post-coital bleeding--a cytologic, colposcopic and histopathologic evaluation. Gynecologic and obstetric investigation. 1998; 45(3):205-8. doi: 10.1159/000009957.

Sahu B, Latheef R, Aboel Magd S. Prevalence of pathology in women attending colposcopy for postcoital bleeding with negative cytology. Archives of Gynecology and Obstetrics. 2007 Nov; 276(5):471-3. doi: 10.1007/s00404-007-0362-0.

Rosenthal AN, Panoskaltsis T, Smith T, Soutter WP. The frequency of significant pathology in women attending a general gynaecological service for postcoital bleeding. An International Journal of Obstetrics and Gynaecology. 2001 Jan; 108(1):103-6. doi: 10.1111/j.1471-0528.2001. 00008.x

Godfrey MA, Nikolopoulos M, Povolotskaya N, Chenoy R, Wuntakal R. Post-coital bleeding: What is the incidence of significant gynaecological pathology in women referred for colposcopy? Sexual & Reproductive healthcare. 2019 Dec; 22:100462.

Yarlagadda S, Diddi R, Narra PJ. Evaluation of women with postcoital bleeding by clinical examination, papsmear, colposcopy and histopathology of cervix. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2018 Jun; 7(6):2184-92.

Apgar BS and Brotzman G. Management of cervical cytologic abnormalities. American Family Physician. 2004 Nov; 70(10):1905-16.

Venkatesh M. A comparative study of Pap smear and colposcopy guided biopsy in the evaluation of unhealthy cervix. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2020 Jun; 9(6):2305-10.

Chaudhary RD, Inamdar SA, Hariharan C. Correlation of diagnostic efficacy of unhealthy cervix by cytology, colposcopy and histopathology in women of rural areas. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2014 Mar; 3(1):213-9.

Kapila K, George SS, Al-Shaheen A, Al-Ottibi MS, Pathan SK, Sheikh ZA, et al. Changing spectrum of squamous cell abnormalities observed on papanicolaou smears in Mubarak Al-Kabeer Hospital, Kuwait, over a 13-year period. Medical Principles and Practice. 2006; 15(4):253-9. doi: 10.1159/000092986.

Abdullah LS. Pattern of abnormal Pap smears in developing countries: a report from a large referral hospital in Saudi Arabia using the revised 2001 Bethesda System. Annals of Saudi Medicine. 2007 Aug; 27(4):268-72. doi: 10.5144/0256-4947.2007.268.

Al-Mikhlafy AA, Abdulaziz M, Shamsher A. Cervical Cytological Findings among Women Attending a Tertiary Care Hospital in Sana’a, Yemen. Yemeni Journal for Medical Sciences. 2018 May; 12(1).

Balaha MH, Al Moghannum MS, Al Ghowinem N, Al Omran S. Cytological pattern of cervical Papanicolaou smear in eastern region of Saudi Arabia. Journal of Cytology. 2011 Oct; 28(4):173-7. doi: 10.4103/0970-9371.86343.

Ghazal-Aswad S, Gargash H, Badrinath P, Al-Sharhan MA, Sidky I, et al. Cervical smear abnormalities in the United Arab Emirates: a pilot study in the Arabian Gulf. Acta Cytologica. 2006 Feb; 50(1):41-7. doi: 10.1159/000325893.