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Re: leep procedure.....and incompetent cervixFrom: Amanda (anonymous@obgyn.net)Mon, 3 Nov 1997 12:58:54 -0600 (CST)
At Sun, 2 Nov 1997, D. Ashley Hill, M.D. wrote: > >At Sun, 2 Nov 1997, anonymous@obgyn.net wrote: > >>my dr did not tell me that a leep procedure...could cause an >>incompetent cervix.... >>it's been over three years since the leep so there will >>be no lawsuit ...so feel comfortable in answering.... >>what other procedure might have been done to prevent this >>secondary infertility...I have no children and i'm 39.. >>this was my first pregnancy and i have no other infertility >>problems...(just a late first marriage and i became pregnant >>on our first try).. > >Your post offers me an opportunity to discuss a number of misperceptions >about LEEP procedures, fertility in patients over the age of 35, and the >decision-making process doctors go through in treating abnormal Pap >smears. First, I'm very sorry that you lost your baby. It's not clear >from your post that the cause of your loss was a ruptured membrane; it >sounds like a fetal demise from another reason. Women over the age of >35 have a higher incidence of miscarriage and stillbirth due to >chromosomal anomalies, which has nothing to do with abnormal Pap smears >or LEEP procedures. Infertility is also more common in women over 35, >as the ovaries "slow down" over time. > >There are a number of ways to treat abnormal Pap smears, but treatment >depends on the extent of abnormality, the age of the patient, and the >options available from your doctor. One can freeze the cervix >(cryotherapy), laser it, LEEP it (using an electrified wire to remove >part of the cervix), or do a cold knife cone biopsy in the operating >room. Every one of these procedures has risks, including cervical >stenosis (extreme narrowing of the cervix), bleeding, inadequate >treatment due to a large lesion, and incompetent cervix. Incompetent >cervix, where the cervix opens up and the baby is delivered at *about* >20 weeks (it varies) is the least likely possibility, and while it's a >known side-effect of cervical surgery, it's also uncommon. When >confronted with an abnormal Pap and biopsy, we decide, along with the >patient, which treatment is necessary. Cryotherapy is less expensive >but, in my opinion, is usually inadequate for more severe abnormalities >or lesions that go up in to the cervix. LEEP and cone biopsy are >better. I rarely use laser, as it's expensive, and, in my opinion, not >any better than LEEP or cold knife cone for most abnormalities. Yes, >they have side effects, but dying of cervical cancer in most cases would >be a *worse* side effect. > >I must admit to significant frustration regarding your comment about >"lawsuits." I understand that you would have liked better informed >consent from your doctor before the LEEP procedure, but would you really >have refused treatment for a seriously abnormal Pap smear/biopsy? I know >of a patient who underwent a hysterectomy because she was literally >bleeding out each month, with a blood count 1/4 of normal and >passing-out spells from anemia due to the bleeding. The bleeding could >not be stopped with medication or minimally invasive surgery, and she >was begging for a hysterectomy. During the procedure there was >apparently a lot of scar tissue (not my patient) and a nick was made in >the bladder, requiring a catheter for 2 months or so. She sued her >gynecologist, even though he warned her the surgery might be complicated >and she desperately wanted treatment. Is is too much to ask that >patients understand that life is full of risks, and that despite our >best efforts, practicing medicine is a complicated job and that >sometimes things happen that are unforseen or due to situations we >cannot control? It's not like doing a brake job. > >I would advise similar patients to undergo a full evaluation for >pregnancy loss, including a variety of tests on the uterus and blood, to >make sure *another* reason does not exist for the lack of a heartbeat at >17 weeks. It's unlikely, although possible, that the cause was an >incompetent cervix, but I always like to make sure I'm not missing >another treatable cause for the pregnancy loss. Good luck to you in the >future. > >-- >Ashley Hill >D. Ashley Hill, M.D. >Associate Director >Department of Obstetrics and Gynecology >Florida Hospital Family Practice Residency >Orlando, FL >I apologize, but I am unable to answer personal e-mail >due to time constraints. > Thank you Dr. Hill for replying to an increasingly frequent concern of many women. I too had the LEEP procedure performed for moderate dysplasia and within a year became pregnant. I was concerned about incompetent cervix or any other complications that may arise. I also continued to have abnormal pap smears for a year followng the procedure and up until week 20 of the pregnancy. My gynecologist at the time however provided a wealth of information so that I felt I was making an informed decision. This I think is the main issue involving medical care-tell me, the patient, all the risks so that I can be involved in decision making and feel confident and responsible later should any complications arise. Not only did my Gyn and his nursing staff explain the various procedures, weigh the pros and cons but also provided an information sheet explaining what I could expect post-procedure. A week later I was well aware of my options and felt secure in the procedure to be performed. I am now 30 weeks into my pregnancy and have thankfully, had no complications. I hope that women will not put off treating cervical dysplasia for fear of future infertility and miscarriage......as this fear is unfounded-and the risk of cervical cancer is much greater. amanda
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