Cervix Treatment May Endanger Pregnancy Later
'Watch and Wait' or Laser Are Often Best Options for Cervical Dysplasia
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- Nearly a threefold risk of miscarriage with laser conization.
- Double the risk with LEEP.
- Laser ablation did not increase risk.
Also, the more procedures a woman had, the significantly greater her risk of spontaneous preterm delivery -- nearly threefold risk -- compared with untreated women, Sadler reports.
The problem likely occurs when the cervix shortens in midpregnancy, explains Sadler. With a smaller cervix to support the fetus, membranes can rupture. Also, less immune-boosting protection from the mother's cervical glands and greater exposure to bacteria put the fetus at risk, she writes.
Her paper makes the case for conservative treatment of young women -- unless they are at high risk for developing cervical cancer. Recurrences of these abnormal cervical cells indicate higher risk, she explains.
Also, women are too often treated for cervical dysplasia the same day as their diagnosis, says Sadler. This often leads to a more radical procedure than is necessary. This same-day service "should be abandoned," writes Sadler. Women should be informed about the risks to future pregnancies. They should also be given antibiotics and steroids if they show early signs of miscarriage, she writes.
'Wait and Watch' Often the Best Option
With the "wait-and-watch" option, Pap smears every six months are necessary, Horowitz says.
But if treatment is needed -- if the lesion has advanced all the way up the cervix -- he does laser ablation because he can limit the width and depth of tissue damage.
LEEP is the most common procedure performed, mainly because the equipment is less expensive so doctors can perform it in their offices, explains Horowitz. "But too many doctors take too much extra tissue when they do LEEP." They don't want pathology reports that leave doubts about whether all abnormal cells have been removed, he explains.
"I've had young patients come to me with hardly any cervix left because they've had so many LEEP procedures," he says. "You can do many laser ablations, too, but you're taking a lot less tissue."