Postpartum Papanicolau (Pap) Smears: A Systematic Review of the Literature

Context: In North America, a Pap smear is traditionally done at the six week postpartum visit, although there is no evidence supporting its efficacy at this time.

Objective: To review the pertinent literature related to the optimal timing of a postpartum Pap smear.

Design: A systematic search of the MEDLINE, CINAHL, Psycinfo, and CochraneLibrary databases was performed up to September 1999 to find all English-language, human, randomized controlled trials of interventions pertaining to postpartum smears conducted within North America, Europe, Australia, or New Zealand.

Main Outcome Measures: The effect of the timing of the postpartum Pap smear on the proportion of dysplastic and non-dysplastic abnormal results requiring further follow-up.

Results: Only 1 RCT met the inclusion criteria. This study randomized 184 women into postpartum PAP smear screening at 4, 6 and 8 weeks. Any abnormal PAP smear was followed up at 3 months with a repeat smear. A statistically significant decrease in inflammatory Pap results was found between smears taken at 8 weeks compared to those taken at 4 and 6 weeks postpartum. A negative history of prior abnormal Pap smears and timing of the postpartum Pap smear were found to have a statistically significant association with a normal smear at 6 weeks and at 8 weeks compared to the 4 week group. The number of patients with dysplasia was too small to draw any conclusions for this group of women.

Conclusion: Delaying the Pap smear until 8 weeks postpartum reduces the number of inflammatory smears. This may not translate into a reduction in the number of follow-up smears, nor is it clear how many of these postpartum smears were necessary in the first place. Further RCT studies should examine what is the optimal timing for the postpartum Pap smear and appropriate follow-up of inflammatory smears.