The association between cervical inflammation and histologic evidence of HPV in PAP smears and adverse pregnancy outcome in low risk population

Maya Nimrodi, Vered Kleitman, Tamar Wainstock, Ofer Gemer, Michai Meirovitz, Eli Maymon, Neta Benshalom-Tirosh, Offer Erez

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objective: Recent studies suggest an association between Human Papilloma Virus (HPV) infection, cervical inflammation and obstetric complications (i.e. spontaneous preterm parturition and cervical insufficiency). It has been proposed that viral inflammation of the placenta causes changes in the mother's immune reaction to bacterial pathogens, which leads to enhanced inflammatory reaction and preterm delivery. Therefore, the aim of this population-based study was to determine the association between abnormal cervical cytology prior to pregnancy and obstetric outcomes. Study design: A Retrospective population-based cohort study was designed, including all women who had a Pap smear up to two years prior to delivery or during first trimester of pregnancy (n = 15,357). Women were divided into the following groups, according to Pap smear results: group 1 – Normal PAP smear (n = 11,261); group 2 – Pap smear with evidence of an inflammatory process (n = 3895); and group 3 – Pap smear with evidence of HPV infection (n = 201). Obstetrical outcomes, gestational age at delivery, and pregnancy complications were compared among the groups. Results: The rate of HPV infection in our study population was 1.3%. The rate of preterm delivery (group 1 – 8.5%, group 2 – 8.5%, group 3 – 7%, p = 0.7), preterm PROM (group 1 – 1.7%, group 2–1.6%, group 3 – 2%, p = 0.66) and cervical insufficiency (group 1 – 0.5%, group 2 – 0.7%, group 3 – 1.5%, p = 0.11) did not differ significantly among the study groups. There was no statistical difference in the rate of premature rapture of membranes, newborn small-for-gestational-age, preeclampsia or placental abruption. Women with abnormal cervical cytology, either due to inflammation or HPV infection, had similar obstetric outcome in comparison to those with a normal cervical cytology. Conclusion: This population-based retrospective cohort study indicates no association between positive HPV testing with Pap smear and obstetric complications such as preterm delivery, cervical insufficiency, placental abruption, PROM, Preterm PROM, neonatal SGA and preeclampsia, in a population with low prevalence HPV infection.

Original languageEnglish
Pages (from-to)160-165
Number of pages6
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
StatePublished - 1 Jun 2018


  • Cervical cytology
  • Cervical incompetence
  • Cervical inflammation
  • Human papilloma virus
  • Inflammatory process
  • Pap smear
  • Placental abruption
  • Preeclampsia
  • Preterm delivery
  • Preterm premature rupture of the membranes
  • Small-forgestational- age neonate

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology


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