What is the appropriate management for a patient with CIN 3 who is pregnant?

In a pregnant patient diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3), the appropriate management is primarily conservative with close monitoring rather than immediate treatment. Colposcopy should be performed during pregnancy, preferably in the late first or early second trimester, to assess the lesion and exclude invasive cancer. However, definitive treatment such as excisional procedures (e.g., LLETZ or cone biopsy) is generally deferred until after delivery unless there is suspicion of invasive disease. This approach minimizes risks to the pregnancy while ensuring careful surveillance of the lesion. Repeat colposcopic assessment may be required in the late second trimester to monitor progression. After delivery, treatment can be safely undertaken if CIN3 persists. Throughout pregnancy, multidisciplinary involvement including obstetrics and colposcopy specialists is essential to balance maternal and fetal safety. Smoking cessation and HIV testing should be considered as part of holistic care. Emotional support and counselling should also be offered due to the psychological impact of the diagnosis during pregnancy NICE CKS.

Recent literature supports this conservative approach, emphasizing that CIN3 in pregnancy rarely progresses rapidly and that invasive procedures carry risks such as bleeding and pregnancy loss. Therefore, expectant management with colposcopic surveillance is the preferred strategy, reserving treatment for postpartum unless invasive cancer is suspected Kim & Shim 2024.