Skip to main content
SpringerLink
Log in

HPV-Infektion in der Schwangerschaft

HPV infection during pregnancy

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Die Prävalenz von HPV(humane Papillomaviren)-Infektionen ist im reproduktiven Alter besonders hoch. Infolgedessen sind die klinischen Auswirkungen einer persistierenden HPV-Infektion auch in der Schwangerschaft keine Seltenheit. Ziel der vorliegenden Arbeit ist es, konkrete Empfehlungen für den Umgang mit klinisch sichtbaren oder subklinischen HPV-Infektionen in der Schwangerschaft zu geben. Jede schwangere Patientin mit Auffälligkeiten in der Zervixzytologie sollte kolposkopiert werden. Die Indikation zur bioptischen Abklärung unter kolposkopischer Kontrolle in graviditate wird analog zum nichtgraviden Status gestellt. Kann ein invasives Zervixkarzinom in graviditate nicht ausgeschlossen werden, ist eine histologische Sicherung mittels Exzision bzw. Schlingenkonisation z. B. in der 16.–20. SSW empfohlen. Bei präinvasiven Veränderungen kann der Schwangerschaftsverlauf in der Regel abgewartet werden. Die Therapie eines invasiven Zervixkarzinoms in der Schwangerschaft ist eine individuelle, interdisziplinäre Entscheidung. Condylomata acuminata in der Schwangerschaft stellen in der Regel keine Indikation für eine primäre Sectio dar. Eine HPV-Impfung in der Schwangerschaft wird nicht empfohlen, es sind jedoch keine schwerwiegenden Komplikationen bei versehentlicher Impfung zu erwarten.

Abstract

Especially during reproductive age the prevalence of human papillomavirus (HPV) infection is high. Therefore clinical effects of a persistent HPV infection in pregnancy are commonly encountered. In this article specific suggestions for treatment of HPV infection in pregnancy are presented. All patients with abnormal cervical cytology in pregnancy should undergo a colposcopy. In case of suspected high-grade dysplasia or invasive cancer a target biopsy should be performed. In preinvasive lesions active surveillance during pregnancy is adequate without a need for surgical intervention. Therapy of invasive cervical cancer in pregnancy is an individual and interdisciplinary decision process. There is no indication for caesarean section due to Condylomata acuminata. HPV vaccination in pregnancy is not recommended, but in case of accidental vaccination no negative effects are to be expected.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Kjaer SK, Breugelmans G, Munk C, Junge J, Watson M, Iftner T (2008) Population-based prevalence, type- and age-specific distribution of HPV in women before introduction of an HPV-vaccination program in Denmark. Int J Cancer 123(8):1864–1870. doi:10.1002/ijc.23712

    Article  CAS  PubMed  Google Scholar 

  2. Muñoz N, Bosch FX, de Sanjosé S, Herrero R, Castellsagué X, Shah KV, Snijders PJ, Meijer CJ (2003) Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 348(6):518–527

    Article  PubMed  Google Scholar 

  3. Petry KU, Luyten A, Justus A, Iftner A, Strehlke S, Reinecke-Lüthge A, Grunwald E, Schulze-Rath R, Iftner T (2013) Prevalence of high-risk HPV types and associated genital diseases in women born in 1988/89 or 1983/84 – results of WOLVES, a population-based epidemiological study in Wolfsburg, Germany. Bmc Infect Dis 13:135. doi:10.1186/1471-2334-13-135

    Article  PubMed  PubMed Central  Google Scholar 

  4. Klug SJ, Hukelmann M, Hollwitz B, Düzenli N, Schopp B, Petry KU, Iftner T (2007) Prevalence of human papillomavirus types in women screened by cytology in Germany. J Med Virol 79(5):616–625

    Article  PubMed  Google Scholar 

  5. Al-Halal H, Kezouh A, Abenhaim HA (2013) Incidence and obstetrical outcomes of cervical intraepithelial neoplasia and cervical cancer in pregnancy: a population-based study on 8.8 million births. Arch Gynecol Obstet 287(2):245–250

    Article  PubMed  Google Scholar 

  6. http://www.awmf.org/uploads/tx_szleitlinien/2016-03-15_S3_LL_Prävention_des_Zervixkarzinoms__Konsultationsfassung.pdf. Zugegriffen: 31. März 2016

  7. Brown DR, Bryan JT, Cramer H, Fife KH (1993) Analysis of human papillomavirus types in exophytic condylomata acuminata by hybrid capture and southern blot techniques. J Clin Microbiol 31(10):2667–2673

    CAS  PubMed  PubMed Central  Google Scholar 

  8. IARC (2012) A review of human carcinogens – biological agents. IARC Monogr Eval Carcinog Risks Hum. 100:255–313

  9. Gravitt PE (2011) The known unknowns of HPV natural history. J Clin Invest 121(12):4593–4599. doi:10.1172/JCI57149

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Miranda PM, Silva NN, Pitol BC, Silva ID, Lima-Filho JL, Carvalho RF, Stocco RC, Beçak W, Lima AA (2013) Persistence or clearance of human papillomavirus infections in women in Ouro Preto, Brazil. Biomed Res Int 2013:578276. doi:10.1155/2013/578276

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Armbruster-Moraes E, Ioshimoto LM, Leão E, Zugaib M (1994) Presence of human papillomavirus DNA in amniotic fluids of pregnant women with cervical lesions. Gynecol Oncol 54(2):152–158

    Article  CAS  PubMed  Google Scholar 

  12. Loyo M, Pai SI, Netto GJ, Tunkel DE (2008) Aggressive recurrent respiratory papillomatosis in a neonate. Int J Pediatr Otorhinolaryngol 72(6):917–920. doi:10.1016/j.ijporl.2008.02.022

    Article  PubMed  Google Scholar 

  13. Castellsagué X, Drudis T, Cañadas MP, Goncé A, Ros R, Pérez JM, Quintana MJ, Muñoz J, Albero G, de Sanjosé S, Bosch FX (2009) Human Papillomavirus (HPV) infection in pregnant women and mother-to-child transmission of genital HPV genotypes: a prospective study in Spain. Bmc Infect Dis 27(9):74. doi:10.1186/1471-2334-9-74

    Article  Google Scholar 

  14. Khaengkhor P, Mairaing K, Suwannarurk K, Thaweekul Y, Poomtavorn Y, Pattaraarchachai J, Bhamarapravatana K (2011) Prevalence of abnormal cervical cytology by liquid based cytology in the antenatal care clinic, Thammasat University Hospital. J Med Assoc Thai 94(2):152–158

    PubMed  Google Scholar 

  15. Goncalves CV et al (2009) Diagnosis and treatment of cervical cancer during pregnancy. Sao Paulo Med J 127(6):359–365

    Article  PubMed  Google Scholar 

  16. Fader AN, Alward EK, Niederhauser A et al (2010) Cervical dysplasia in pregnancy: a multiinstitutional evaluation. Am J Obstet Gynecol 203(2):113 e1–113 e6

    Article  PubMed  Google Scholar 

  17. Lellè R, Küppers V (2008) Kolposkopie in der Praxis. Springer, Heidelberg

    Google Scholar 

  18. Yost NP, Santoso JT, McIntire DD, Iliya FA (1999) Postpartum regression rates of antepartum cervical intraepithelial neoplasia II and III lesions. Obstet Gynecol 93(3):359–362

    CAS  PubMed  Google Scholar 

  19. Vlahos G, Rodolakis A, Diakomanolis E, Stefanidis K, Haidopoulos D, Abela K, Georgountzos V, Michalas S (2002) (2002). Conservative management of cervical intraepithelial neoplasia (CIN(2–3)) in pregnant women. Gynecol Obstet Invest 54(2):78–81

    Article  CAS  PubMed  Google Scholar 

  20. Paraskevaidis E, Koliopoulos G, Kalantaridou S et al (2002) Management and evolution of cervical intraepithelial neoplasia during pregnancy and postpartum. Eur J Obstet Gynecol Reprod Biol 104(1):67–69

    Article  PubMed  Google Scholar 

  21. Robinson WR, Webb S, Tirpack J, Degefu S, O’Quinn AG (1997) Management of cervical intraepithelial neoplasia during pregnancy with LOOP excision. Gynecol Oncol 64(1):153–155

    Article  CAS  PubMed  Google Scholar 

  22. Kaplan KJ, Dainty LA, Dolinsky B et al (2004) Prognosis and recurrence risk for patients with cervical squamous intraepithelial lesions diagnosed during pregnancy. Cancer 102(4):228–232

    Article  PubMed  Google Scholar 

  23. Mitsuhashi A, Sekiya S (2000) Loop electrosurgical excision procedure (LEEP) during first trimester of pregnancy. Int J Gynaecol Obstet 71(3):237–239

    Article  CAS  PubMed  Google Scholar 

  24. Henning U et al (2002) Der verdächtige Abstrich in der Schwangerschaft. Dtsch Arztebl 99:A2047–A2051

    Google Scholar 

  25. www.awmf.org/uploads/tx_szleitlinien/032-033OLl_S3_Zervixkarzinom_2014-10.pdf. Zugegriffen: 31. März 2016

  26. Van Calsteren K et al (2010) Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J Clin Oncol 28(4):683–689

    Article  PubMed  Google Scholar 

  27. Căpîlna ME, Szabo B, Becsi J (2016) Radical trachelectomy performed during pregnancy: a review of the literature. Int J Gynecol Cancer 26:758

    Article  PubMed  Google Scholar 

  28. Sood AK, Sorosky JI (1998) Invasive cervical cancer complicating pregnancy. How to manage the dilemma. Obstet Gynecol Clin North Am 25(2):343–352

    Article  CAS  PubMed  Google Scholar 

  29. Loibl S, Han SN, von Minckwitz G et al (2012) Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol 13(9):887–896. doi:10.1016/S1470-2045(12)70261-9

    Article  CAS  PubMed  Google Scholar 

  30. Sood AK, Sorosky JI, Mayr N, Anderson B, Buller RE, Niebyl J (2000) Cervical cancer diagnosed shortly after pregnancy: prognostic variables and delivery routes. Obstet Gynecol 95(6 Pt 1):832–838

    CAS  PubMed  Google Scholar 

  31. Köhler C, Oppelt P, Favero G, Morgenstern B, Runnebaum I, Tsunoda A, Schmittel A, Schneider A, Mueller M, Marnitz S (2015) How much platinum passes the placental barrier? Analysis of platinum applications in 21 patients with cervical cancer during pregnancy. Am J Obstet Gynecol 213(2):206.e1–206.e5. doi:10.1016/j.ajog.2015.02.022

    Article  Google Scholar 

  32. Koutsky L (1997) Epidemiology of genital human papillomavirus infection. Am J Med 102(5A):3–8

    Article  CAS  PubMed  Google Scholar 

  33. Hillemanns P, Breugelmans JG, Gieseking F, Bénard S, Lamure E, Littlewood KJ, Petry KU (2008) Estimation of the incidence of genital warts and the cost of illness in Germany: a cross-sectional study. BMC Infect Dis. doi:10.1186/1471-2334-8-76

    PubMed  PubMed Central  Google Scholar 

  34. Leitlinie der Deutschen STD-Gesellschaft (2010): Condylomata acuminata und andere HPV-assoziierte Krankheitsbilder von Genitale, Anus und Harnröhre

  35. Silverberg MJ, Thorsen P, Lindeberg H, Grant LA, Shah KV (2003) Condyloma in pregnancy is strongly predictive of juvenile-onset recurrent respiratory papillomatosis. Obstet Gynecol 101(4):645–652

    PubMed  Google Scholar 

  36. Hillemanns P (2014) Ist eine HPV-Impfung nach Konisation sinnvoll? Geburtshilfe Frauenheilkd 74:710–711

    Article  Google Scholar 

  37. The college of Family Physicians of Canada (2012) Human papillomavirus vaccine and pregnancy. Can Fam Physician 58(3):268–269

    Google Scholar 

  38. Ackermann S, Gehrsitz C, Mehlhorn G, Beckmann MW (2006) Management and course of histologically verified cervical carcinoma in situ during pregnancy. Acta Obstet Gynecol Scand 85(9):1134–1137

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland

    C. Goldnau

  2. Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Deutschland

    P. Hillemanns

Authors
  1. C. Goldnau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Hillemanns
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Goldnau.

Ethics declarations

Interessenkonflikt

P. Hillemanns erhielt Vortragshonorare von SPMSD, Roche, Hologic. Die Frauenklinik der MHH erhielt Forschungsunterstützung durch GSK, Abbott. C. Goldnau gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

R. Kimmig, Essen

A. Köninger, Essen

I. Mylonas, München

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goldnau, C., Hillemanns, P. HPV-Infektion in der Schwangerschaft. Gynäkologe 49, 599–606 (2016). https://doi.org/10.1007/s00129-016-3917-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00129-016-3917-y

Schlüsselwörter

Keywords

Search

Navigation