Barbara S. Apgar

TRIAGE OF THE ABNORMAL PAPANICOLAOU SMEAR IN PREGNANCY

Triage of the abnormal Papanicolaou smear in pregnancy requires colposcopic evaluation and directed biopsy. If histologic cervical intraepithelial neoplasia is confirmed, the patient can be managed with observations and can be re-evaluated in the postpartum period. If evidence of microinvasion is present, conization must be performed. For patients with invasive disease, a delay in therapy until fetal maturity is achieved does not compromise survival.

ASCCP Colposcopy Standards: How Do We Perform Colposcopy? Implications for Establishing Standards

Objectives The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to colposcopy and biopsy for cervical cancer prevention in the United States. The recommendations were developed by an expert working group appointed by ASCCPs Board of Directors. Working group 3 defined colposcopy procedure guidelines for minimum and comprehensive colposcopy practice and evaluated the use of colposcopy adjuncts. Materials and Methods The working group performed a systematic literature review to identify best practices in colposcopy methodology and to evaluate the use of available colposcopy adjuncts. The literature provided little evidence to support specific elements of the procedure. The working group, therefore, implemented a national survey of current and recent ASCCP members to evaluate common elements of the colposcopy examination. The findings of this survey were modified by expert consensus from the ASCCP Colposcopy Standards Committee members to create guidelines for performing colposcopy. The draft recommendations were posted online for public comment and presented at an open session of the International Federation for Cervical Pathology and Colposcopy 2017 World Congress for further comment. All comments were considered in the development of final recommendations. Results Minimum and comprehensive colposcopy practice guidelines were developed. These guidelines represent recommended practice in all parts of the examination including the following: precolposcopy evaluation, performing the procedure, documentation of findings, biopsy practice, and postprocedure follow-up. Conclusions These guidelines are intended to serve as a guide to standardize colposcopy across the United States.

Family Planning and Contraception

Contraceptive agents provide both irreversible and nonreversible methods of protection from unwanted pregnancy. Decisions about the selection of methods affecting human sexuality must be made with full informed consent with a respect for each individual’s personal sexual practices and beliefs. Although no method or agent provides absolute protection, current agents offer high effectiveness, minimal side effects, and convenience. It is necessary to balance these components with cost data. Trussell et al. developed an economic model to compare the effectiveness and costs per person of 15 contraceptive methods and found that the up-front acquisition costs of contraceptives are inaccurate predictors of the economic value of competing contraceptive methods, and that investments in contraception provide substantial economic savings and societal benefits.1 Regardless of payment mechanism, contraception saves money by preventing unwanted pregnancy, and improved cost savings can be achieved by optimizing appropriate and consistent use.