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Pregnancy brings a lot of change to your body and to your lifestyle as doctors appointments and hospital visits become more frequent than you are typically used to. Pregnancy can make you question almost everything about your health, body, baby and mind. 

When it comes to tests and screenings to ensure everything is running smoothly, it is understandable to wonder whether the test itself could somehow cause harm or is even necessary.

The reassuring answer is that both Pap smears and diagnostic ultrasound have established roles in women’s healthcare and pregnancy. However, “safe” does not mean that every test is necessary at every stage of pregnancy.

The important question is not simply “Can I have this test while pregnant?” but rather: “Is this test appropriate for me, at this point in my pregnancy, for this particular reason?” This is where your healthcare provider brings in their expertise and guidance. 

Separate the facts with us from some of the common myths.

What Does a Pap Smear Actually Do?

A Pap smear, or cervical cytology test, collects cells from the cervix so they can be examined for abnormalities that could represent precancerous changes or cervical cancer. It does not examine the baby.

During a pelvic exam, a healthcare provider gently inserts an instrument called a speculum into the vagina to hold the walls apart and view the cervix, then uses a small brush or spatula to collect a sample of cells. 

The cervix, which is the lower part of the uterus that opens into the vagina. It is generally the best place to collect these cells because this is where almost all cervical cancers originate in a precise area called the transformation zone.  These cells are sent to a laboratory to be examined under a microscope for abnormalities so that early treatment can help prevent cancer. 

During pregnancy, the cervix naturally undergoes hormonal and structural changes. These changes can sometimes make cervical cells more difficult to interpret, but they do not mean that cervical screening is inherently dangerous.

A recent review of cervical cytology during pregnancy found that cytology can be safely performed when appropriately indicated, although pregnancy-related changes can make interpretation more challenging (Brockmeyer et al., 2025).

South African guidance is also clear that pregnancy does not automatically prevent cervical screening. The National Integrated Maternal and Perinatal Care Guidelines (2024) state that pre-natal screening can be performed up to 20 weeks of gestation when appropriate, helping to prevent missed opportunities for screening.

However, this does not mean every pregnant woman needs a Pap smear.

Your Need For Cervical Screening Depends On The Following Factors

Your Age

Your age can influence when cervical screening starts and how often it is recommended, because HPV infection and the risk of persistent HPV-related cervical changes vary across different age groups. Screening recommendations are therefore tailored to age rather than applying the same schedule to everyone.

Your Previous Screening Results

Previous Pap smear or HPV results help your doctor understand your current level of cervical risk. A history of normal results may mean routine screening is appropriate, while previous abnormalities may require closer monitoring or follow-up.

Your HPV Status

High-risk types of HPV are the main cause of cervical cancer, particularly when an infection persists over time. Knowing whether high-risk HPV is present can therefore help determine whether you need routine screening or additional follow-up.

Your Previous Cervical Abnormalities

Previous abnormal cervical cells can remain relevant even if your most recent test was normal. The type and severity of the previous abnormality can affect how closely your cervix needs to be monitored.

Your HIV Status and Other Risk Factors

A weakened immune system can make it harder for the body to clear HPV, increasing the likelihood of persistent infection and cervical changes. This is why women living with HIV or certain other conditions affecting immunity may have different screening recommendations.

When Your Last Screening Test Was Performed

If you recently had a normal screening result, you may not need another test simply because you are pregnant. If you are overdue, have never been screened, or need follow-up from a previous result, your doctor may recommend screening during pregnancy.

The Screening Guidelines That Apply To You

Cervical screening recommendations differ between countries and can change as new evidence and testing methods become available. Your healthcare provider will consider the South African guidelines and your individual history when deciding which test you need and when.

In South Africa, cervical screening is increasingly moving towards high-risk HPV testing as the primary screening method, rather than relying solely on traditional cytology.

So if your doctor discusses cervical screening during pregnancy, the decision should be based on your individual screening history rather than pregnancy alone.

From the Maxima Consultation Room

These are myths, beliefs and misinformed guidelines we’ve encountered and debunked in our offices over time. 

Myth 1:
“A Pap Smear Can Touch or Harm the Baby”

This is completely false. 

The cervix is separate from the baby’s environment inside the uterus. Therefore, during a cervical screening examination, a speculum is gently placed inside the vagina so that the cervix can be seen. A small collection device is then used to collect cervical cells.

The examination does not involve entering the uterus or touching the baby.

There can be some mild discomfort, pressure or light spotting afterwards, particularly because pregnancy increases blood flow to the cervix. Your healthcare professional should explain what to expect and investigate significant bleeding, pain or other concerning symptoms.

The South African maternal care guideline recommends using an appropriate plastic brush/broom when collecting a Pap smear during pregnancy to minimise cervical trauma.

Myth 2:
“If I’m Pregnant, I Should Never Have a Pap Smear”

This statement is also false— but with an important qualification. Pregnancy itself does not make cervical screening unsafe. The question is whether screening is due or clinically indicated.

If you are already up to date with cervical screening and have no reason for another test, your doctor may decide that screening can wait until after pregnancy. If screening is due, however, pregnancy does not necessarily mean it must automatically be postponed.

If you have symptoms such as unusual bleeding, a visible cervical lesion or an abnormal previous screening result, evaluation may be important rather than simply waiting until after delivery.

Myth 3:
“The Pap smear is going to hurt my baby”

Not at all. A Pap smear collects cells from the cervix, which is the lower part of the uterus. The sampling does not enter the uterus or come into contact with your baby.

You may experience some pressure or mild discomfort during the examination, and light spotting can happen afterwards because the cervix is more sensitive during pregnancy.

Myth 4:
“I had a little bleeding after my Pap smear. Should I be worried?”

A small amount of spotting can occur after cervical sampling, particularly during pregnancy when there is increased blood flow to the cervix. It does not automatically mean that anything is wrong.

However, bleeding during pregnancy should never simply be dismissed. If the bleeding is heavy, persistent, accompanied by significant pain, or you are otherwise concerned, contact your healthcare provider so that you can be assessed.

Myth 5:
“My Pap smear came back abnormal. Does that mean I have cancer?” 

An abnormal result also does not automatically mean cancer.

HPV infection and cervical cell changes are common, and pregnancy can create cervical changes that complicate interpretation. Abnormal findings may therefore require follow-up rather than immediate treatment.

For women who do require further assessment, pregnancy-specific approaches are used. Current guidance indicates that clinically indicated colposcopy and biopsy can be performed when necessary, although procedures such as endocervical curettage and treatment of precancerous lesions are generally avoided during pregnancy unless cancer is suspected.

Myth 6:
“Can I have a Pap smear and an ultrasound on the same day?”

In many situations, yes. A pap smear and an ultrasound are completely different examinations that answer different questions. 

A Pap smear looks at the cells of the cervix, while an ultrasound uses sound waves to assess the pregnancy. Having either one, or both on the same day, does not interfere with the other.

Myth 7:
“Why would my doctor recommend a Pap smear if I have no symptoms?”

Cervical screening is preventive. The purpose is to identify HPV infection or cervical cell changes before they become a problem or cause symptoms.

Being pregnant does not protect you from cervical abnormalities, but it also does not mean that every pregnant woman automatically needs a Pap smear. The decision should be based on your screening history and individual risk.

Your doctor considers factors such as your age, previous screening results, HPV status, history of cervical abnormalities and when your last screening was performed. From there, they can decide whether screening during pregnancy is appropriate or whether it can safely wait until after delivery. 

Screening Is About Information, Not Interference

One of the most persistent pregnancy myths is that medical tests are somehow “interfering” with a pregnancy that would otherwise be left alone.

Prenatal care is not about performing tests for the sake of performing tests. It is about identifying information that can help your healthcare team make better decisions. A cervical screening test can identify abnormal cervical cells.

 The decision to do a pap smear during pregnancy should be based on your medical history, your pregnancy, your gestational age and the clinical question your healthcare professional is trying to answer.

When Should You Speak to Your Doctor?

If you are pregnant and have been advised to have a Pap smear, ultrasound or other investigation, it is completely reasonable to ask: “Why do I need this test?”

You can also ask your doctor:

• “What are you looking for?”
• “Is this test routine or because of something specific in my history?”
• “Is it safe at this stage of pregnancy?”
• “What happens if the result is abnormal?”
• “Do I need the test now, or can it wait until after delivery?”
• “Are there alternatives?”
• “What symptoms should I look out for afterwards?”

Good prenatal care should leave you feeling informed, not frightened.

If you have symptoms such as unexplained vaginal bleeding, persistent pelvic pain, unusual discharge or other changes that concern you, don’t assume they are simply “part of pregnancy”. Speak to your healthcare provider.

The Maxima Takeaway

Pregnancy does not mean putting every test on hold — and it does not mean every test is automatically necessary. 

Pap smears and diagnostic ultrasounds can have an important place in pregnancy when appropriately indicated and performed by trained healthcare professionals. 

The safest approach is not to avoid screening out of fear, or to pursue every available test for reassurance. It is to have the right test, for the right reason, at the right time.

Ready to feel more informed about your pregnancy?

Your questions are part of your care — and you deserve answers that make sense.

Talk to the Maxima Women’s Health team about your pregnancy screening questions and what is appropriate for you.

Need more information about the possibilities of your health going forward?

Bring your questions with you after you book your consultation.

At Maxima Women’s Health you can talk to our professionals, they will guide you through the benefits, limitations, side effects and practical considerations so you can make an informed decision.