Background: There have been few studies documenting the optimal cervical cytologic technique in pregnancy. This study was initiated to investigate the effectiveness and safety of two standard techniques.
Methods: Two hundred twenty-two new obstetrical patients at a family practice residency program signed informed consent, were enrolled, and were randomized for cervical cytologic screening using either Zelsmyr Cytobrush and Ayre spatula or Dacron swab and Ayre spatula. The pathologists were blinded to the study, and results were reported with standard Bethesda System nomenclature. Patients were asked about complications at follow-up visits. Statistical analysis was performed using Fisher's exact test and the two-sample t test, with statistical significance set at P < .05.
Results: The Cytobrush-spatula technique yielded 95.6% (108/113) smears with adequate endocervical cells, as compared with 69.7% (76/109) of smears obtained with the Dacron swab and spatula (P = < .0001, odds ratio 9.38). Cytologic atypia, defined as noninflammatory cellular abnormalities, was uncovered on 15.9% (18/113) of the smears obtained with the Cytobrush and spatula technique and on 13.8% (15/109) of the smears obtained with the Dacron swab and spatula (P = .7082). The complication rate, which included spot bleeding and spontaneous abortion, occurred in 6.5% (7/108) of the smears obtained with the Cytobrush and 3.8% (4/105) of the smears obtained with the Dacron swab (P = .54).
Conclusions: The Cytobrush-spatula technique significantly increased endocervical cell yield, did not increase detection of cytologic atypia, and did not increase the risk of adverse maternal or fetal outcomes when used for cervical cytologic screening during pregnancy. These results support the use of the Cytobrush-spatula technique over the swab and spatula for obtaining cervical cytologic smears in pregnancy.