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Re: CIN 3 in pregnancy From: steve (steve@dhngwe2.db.healthlink.org.za) Thu Aug 26 16:23:14 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DuboseTerryJ@exchange.uams.edu: "URGENT Practice Expense Survey" Previous message: Anna Meenan, MD: "Re: Hepatitis C testing" Maybe in reply to: John Teo: "CIN 3 in pregnancy" Next in thread: Deborah Wage: "Re: CIN 3 in pregnancy" In Am. J. Obstet. Gynecol 157:932-937, 1987 Benedet JL et al advocated colposcopically directed biopsies in pregnant women "only if the lesions seen suggested possible microinvasive or invasive carcinoma" and showed that only 2% had progression of cytologic abnormalities postpartum, while 39% showed marked improvement. They did however suggest that women over 30 should have a biopsy even if colposcopy did not suggest invasion, but that follow-up colposcopy postpartum was the correct management There have been several studies demonstrating that cryotherapy of CIN is as effective as laser cone or vapourisation, and considerably cheaper. More recently LLETZ has become more popular as it produces a specimen for histological evaluation while effectively excising the lesion, but there has never been any suggestion that cryotherapy is a less adequate treatment. The same author with slightly different colleagues reported on ten year follow up of cryosurgically treated CIN in Am. J. Obstet. Gynecol. 157:268-273, 1987 and showed an 85% success rate. At 1 year the success rate was 94%. A 91% success rate at 1 year was reported for LLETZ by Wright TC et al. in Obstet Gynecol 79: 173-178, 1992. > I have a 37 years old patient Para 1 whose pap smear showed mild > dyskaryosis. A colposcopy showed some acetowhite areas and a cervical > biopsy was performed. Diathermy of the area was also performed in the > same sitting. > The biopsy result came back as CIN3. Unfortunately she is found to be > 12 weeks pregnant. > > Any comments about the situation? > My plan now is to do colposcopic surveilliance during her pregnancy > making sure that there is no invasive features and then offer her LLETZ > post delivery. > > Questions > 1) Does anybody agree with above? > 2) Assuming that she is not pregnant, does anybody think that diathermy > is an adequate treatment? I would have thought that it may not be > adequate as you may not be sure of the depth of the lesion you destroy > and even the extent of it with the concept of field change. Therefore > excision method such as LLETZ would be more appropriate follow up > treatment I presume. Any comments? > 3) Finally any place for less extensive treatment for CIN 3 other than > the commonly offered LLETZ or Cone biopsy? > Based on the evidence and the experience of the last 10 years, my opinions are as follows: 1) I agree that no further treatment is required during the pregnancy, but suggest no need for colposcopy until postpartum 4-6/52. 2) Ball diathermy has a lower success rate than cryo, laser or LLETZ, but may still be sufficient - you're going to follow up anyway, so wait and see. 3) Most definitely - there are, as I have shown above, good studies confirming a place for cryo - the failure rate is the same no matter what grade of CIN. I would be interested to hear other opinions and experiences. By the way I hate biopsying in pregnancy and go perhaps too far the other way to try to establish a diagnosis on colposcopy alone. So far I haven't had any disasters, touch wood. -- Steve Raymond Head of O & G Empangeni Hospital SOUTH AFRICA Next message: DuboseTerryJ@exchange.uams.edu: "URGENT Practice Expense Survey" Previous message: Anna Meenan, MD: "Re: Hepatitis C testing" Maybe in reply to: John Teo: "CIN 3 in pregnancy" Next in thread: Deborah Wage: "Re: CIN 3 in pregnancy"

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