How do you manage a screening pap smear result of HSIL and HPV16+ in a first trimester pregnancy?

Colposcopy to rule out invasion; if invasion is suspected, then biopsy. Otherwise, wait until delivery and re-evaluate.

It is unlikely that invasive disease will develop in the short time of gestation.

I believe these are the ASCCP guidelines.

Agree with @Dr. First Last. Colposcopy withOUT endocervical curettage. Biopsy any visible lesion concerning for invasion. Then depending on any biopsy results and level of concern (by the physician or the patient), can either repeat colposcopy later on pregnancy or wait until postpartum.

As @Dr. First Last mentioned, is it until progression will occur in a short time period, but I have had some patients that feel better with the option of immediate colposcopy as well as another colposcopy in the late second or third trimester.