Improving uptake of Cervical Screening in pregnant and postnatal women

Cervical screening rates are at their lowest for almost 30 years. The peak incidence of cervical cancer is in the age group 25-30y in whom the cervical screening rate is around 60%. During pregnancy ~50% of women are invited for their cervical screening ‘smear’ test, most of which are deferred. By the end of pregnancy many women are not up to date with their screening and by 6 months’ post-natal only half of these women have had their smear test taken. Given the amount of contact pregnant women have with healthcare staff during and immediately after pregnancy there is a real opportunity to improve uptake of cervical screening.

If a woman has previously had a normal smear test when invited during pregnancy, she can defer this until 12 weeks postnatal. The woman, her midwife or a clinical member of the GP practice should notify the GP practice non-clinical administration staff to inform the Open Exeter call and recall system. This prompts current invitations to attend for screening to cease and then invites the woman again once she is no longer pregnant.

National guidance recommends certain situations when women should still have a smear when pregnant in their GP practice:

· If a woman has previously defaulted her screening invitations i.e. is a poor attender for cervical screening;

· If a woman had had treatment for CIN (cervical intraepithelial neoplasia), but not all abnormal areas were removed (incomplete excision / margins) and is due her test of cure smear;

· If a woman has previously had a LLETZ/cone biopsy/trachelectomy for cervical cancer and is within 10 years post treatment she still requires annual smears.

We have created a clear flowchart for Community Midwives and GP Practice staff (clinical and non-clinical) to follow, so that women can be given appropriate advice about whether or not they need to have their smear conducted in pregnancy. This is based on the RCOG Patient Information Leaflet ‘Cervical smears in pregnancy’. We have created a proforma letter that the midwife can complete and give to the woman explaining the reason why she is recommended to have a smear test in pregnancy. This will allow the GP practice staff, who are undertaking the smear test, to be are aware of the clinical reason for undertaking the smear and will hopefully reassure them and the woman that performing a smear in pregnancy is not harmful to the pregnancy.

Taunton & Somerset NHS Foundation Trust

 

Smear in Pregnancy Flowchart

Smear Follow Up Letter for Midwifes

 

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