Pregnancy after Lletz - consultant or not?

[McMum84]

Hi,

After people's experiences with pregnancy after a lletz to see if I'm being neurotic or not! Were you offered a consultants appt to check your cervix during pregnancy?

I had a lletz procedure about 4/5 years ago, which was done under general anesthetic - I think Lletz's are normally done under local, so I'm not sure if that means that more cervix was taken than a normal lletz or if it was because they were taking a womb biopsy at the same time.
I know at the time the consultant mentioned it would need monitoring when I was pregnant in the future.
I'm now 31 weeks pregnant. I've mentioned my lletz at 2 of my midwife appts and she say's it's nothing to worry about. I had an appointment with a midwife from another area last week (as I'm hoping to birth in a local midwife led centre which is just outside my normal hospital area). The new midwife said I should have seen a consultant to monitor my cervix because of the lletz, but she didn't seem to think it was worth doing now.
I just had my 31 week Dr check up and asked her, to which her response was "you're still pregnant aren't you?" and said it was up to my midwife to refer me or not. No one has even looked at my notes from my lletz procedure, I can't remember very much about the details of what was done as it wasn't relevant at the time and I trusted it would be picked up when I was pregnant.
I know it's not going to mean anything particularly dire at this stage - but I would like to know if it's looking weak and whether I should be doing anything/expecting an early birth etc - if only so I can change my plans with my job. I just feel a bit in the dark and would like to know if I'm being silly expecting a consultants appt or not!
TIA :-)

Me. Had lletz about 5 years ago, as well as biopsy. Everything was fine. I've been under consultant care but not for that (for my thyroid) and although I've mentioned it more than once I've been told that my trust don't do cervical scans after just one round of lletz. I'm now 30 weeks and everything is fine, touch wood.

I'm having checks at the moment to determine cervical length but I believe this will be stopping at around 28 weeks provided everything still looks 'normal'. Have you had any checks in your cervix at all so far? I.e. During scans etc.

My consultant told me that so long as the cervix hasn't shown any signs of premature dilation by late-mid pregnancy, there isn't really any significant risk of going into labour earlier than with any other non-LLETZ pregnancy, but if you're feeling anxious and haven't had any other checks in your cervix so far I'd probably push them to get a decent idea of its length at the moment even if they wouldn't be able to definitely pin anything down.

The NHS are quite reluctant to perform cervical scans on patients who have only had one LLETZ procedure as there isn't a notably higher risk but in my experience if you really push to have your mind put at rest and explain to them that it's making you anxious they'll at least arrange for you to speak to a specialist. Good luck. :)

Thanks both :-)

I've not had any checks to my cervix during normal scans, everyone I've mentioned it to has been a bit dismissive without giving any reasons - one midwife hadn't heard of lletz procedures and my Dr didn't look at my notes or explain why it wasn't a problem. Which would be fine if my initial consultant who did the op hadn't said there was a potential problem and my second midwife hadn't said I should have seen a consultant!

In my crazy googling I did find this though: www.qmul.ac.uk/media/news/items/smd/82894.html

which agrees with what you both say - that's it's likely it's not a problem.
I wish we didn't have to resort to google/forums to find out these things, I know NHS staff are stretched but it doesn't take that long just to explain something without being dismissive or making the patient feel like they are making a fuss. I wouldn't be allowed to do that in my job!

Think I'll just relax, but will probably cancel some of my work travel commitments that are after 34 weeks just in case!

good luck with both of your pregnancies! :-D

I've had cervical scans because I've had. 2 x lletz plus ERPC's for miscarriages (x. 3)

But they stopped at 20 weeks asu cervix wasn't shortening and all is ok.

I'm under consultant care but it's for everything all together rather than just having lletz.

If there was a problem, it would've shown by now

I was referred to a consultant by my midwife. I had a lletz done under general anaesthetic in June 2014 and I saw my consultant when I was 20 weeks, about three weeks ago.

He read my notes, and said normally one procedure isn't an issue, however, they removed "a chunk" of my cervix - far more than average, and he wanted me to have a scan and see him the following week.

The treatment diverged dramatically on the measurement - above 2.5cm of cervix no action. Below 2.5cm, a cervical stitch and high risk pregnancy. I was warned to expect the worst.

However, I either have the world's longest, or quickest growing cervix. It was 3.5cm and I'm now happily 23 weeks and discharged back to midwife care.

The consultant said that the progesterone released during pregnancy can stimulate cervical growth, so that is probably what happened.

I've had two LETTZ treatments and my gynaecologist said my cervix is pretty short now, so I'm assuming I will be monitored (I'm only 6 weeks at the moment). I'm certainly going to be pushing for it and if necessary I'm prepared to pay privately for cervical scanning.

I had cervical scans up until 34 weeks due to lletz treatment the previous year. Main reason I was referred to be checked was because I had been referred for something else and mentioned that I had had some bleeding.

I had had CIN2 and for me the scans were beneficial as my cervix had shortened and I had to use progesterone pessaries for the remainder of my pregnancy and was signed off at 31 weeks to rest

For some lletz does not affect pregnancy, everyone is different. If you are worried insist on being referred for an internal scan to check this.

I had LETTZ treatments & a large biopsy but recieved no extra care or scans.

I really wouldn't worry as your 31 weeks now.

Good luck with the rest of your pregnancy.

Hi OP- also had a lletz around 5 years ago.

Prg with no2 but with DC1 had an extra check/internal scan at 16 weeks and this time its the same.
DS was born exactly on his due date btw. They have also put in my notes I'm technically "high risk" until they confirm all is fine. Im amazed your team have been quite so relaxed?

From what I've read on this it varies hugely from hospital to hospital as to whether they put you under consultant care or not. I was for my first pregnancy and this current one. I am lucky in that my hospital is a teaching hospital and they are very thorough (sometimes overly so which comes with its own issues!). My first pregnancy my cervix was measured every two weeks from 12 weeks to check for shortening. As there was no shortening by 20 weeks then the cervical clinic signed me off.

This pregnancy they measured at 12 weeks, 16 weeks and then 22 week scan and again signed me off as no shortening.

The longer ago the procedure from your pregnancy the lesser the risk of shortening I believe so it sounds as though your risk is not as great as if you'd had the procedure in the last year, but I am surprised they didn't check on this after your booking in appointment. Risk also obviously depends on how much was removed.

I agree with others that your risk has decreased now you're 31 weeks although your midwife's comment about you still being pregnant is awful!

Good luck with the final run. I would definitely cancel any work travelling after 34 weeks but only because you're likely to be knackered!