Navigating the challenge of high-grade cervical lesions (CIN3) in pregnancy: a near miss

In this case, a pregnant Indigenous woman presented with high-grade cervical lesions (high-grade squamous intraepithelial lesion (HSIL), cervical intraepithelial neoplasia grade 3 (CIN2-3) and was lost to follow-up for over 5 years, posing a unique management challenge. Despite higher regression rates in pregnant women, personalised care was crucial due to potential pregnancy-related intervention risks. This case underscores the complexities of managing high-grade cervical lesions in pregnancy and highlights the significant burden of cervical cancer within Aboriginal and Torres Strait Islander communities. It emphasises the urgent need for equitable screening access, patient-centred care and culturally sensitive education among vulnerable populations. Of particular note is the case's uniqueness, with the patient's CIN3 diagnosis persisting for over 5 years and spanning three pregnancies without definitive management. Post partum, a subsequent LLETZ revealed extensive HSIL (CIN3) involving ectocervical and endocervical margins. Due to margin involvement, the patient now requires ongoing surveillance, with continued risk of being lost to follow-up due to the factors described.