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 @David G. Mutch. 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 @...