Last Modified: September 14, 2008
Dear OncoLink "Ask The Experts,"
I am pregnant with my first child, (15 weeks) but have had 2 cervical biopsies in the past. I had a LLETZ (large loop excision of the transformation zone) biopsy 10 years ago for Cervical Intraepithelial Neoplasia (CIN2), and a NETZ (needle excision of the transformation zone) biopsy 5 years ago for CIN1. Have been all clear since. My doctor told me [that] if I [had] undergone 2 cold knife cone biopsies, I may have [had] a weak cervix and needed a stitch, but other biopsy treatments I’ve had may not require that. Can you tell me whether the LLETZ and NETZ I’ve had are safer than the cold knife biopsies? Am I still at risk of a weak cervix? My cervix currently measures 3.7cm, and I will probably be monitored closely unless I choose to opt for the stitch.
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
Management of pregnancy after cervical conizations [cold knife cone, or LEEP ( loop electrosurgical excision procedure ) /LLETZ (large loop excision of the transformation zone ) is controversial. After conization, patients who achieve pregnancy are at increased risk for preterm delivery. While most studies tend to group these procedures together in their analysis, common sense would dictate that the amount of tissue that is removed at the time of the procedure would be more important in determining risk for cervical incompetence than the way the biopsy is performed (some cold knife cones are small, and some LEEPs are large, etc). Many obstetricians would follow cervical length measurements during pregnancy, and only intervene with a cerclage (cervical stitch) or bedrest if there is shortening of the cervix.