Pregnancy following Lletz and biopsy

[BarryTheKestrel]

In 2016 my smear came back as abnormal and I had 2 Lletz procedures and a biopsy for CIN3.
I'm now 10+6 and was going through some paperwork and found the advice leaflet from my procedure that said to inform midwife early in any subsequent pregnancy. When I had my booking appointment my midwife checked my last smear result which came back clear and signed it off. I didn't think about previous treatments at this time.

I've now done the terrible thing of googling and have found that these procedures can cause issues in pregnancy and during labour.

I've text my midwife this evening as her voicemail said to text if not urgent. I've asked her advice. But in the meantime can anyone let me know what I should be expecting? I've read about the potential of early labour, or of failure to progress due to scarring. I've also read that most have been referred for internal scans at 16+ weeks and the potential of a cervical stitch.

My last labour in 2015 was a catalog of errors with significant failure to progress ending with theatre, episiotomy and forceps delivery and various issues afterwards. As such I want to be as prepared as I can for any issues this time.

Thanks in advance.

I had CIN3, followed by LLETZ in 2016. Now 10 weeks with#2, so a very very similar history to yours. I told my midwife all about it at first appointment. She said it was a very common procedure, if I hadn't needed it under general anaesthesic then it wasn't a major op, so no need for a consultant referral, they'd just note it and keep an eye on things. But there was no reason to think it would be a problem.
I hope she's right!!

Let's hope so! My concern is definitely around the biopsy as from what I've read that's where the issues can lie more than from the LLETZ. I'm hoping it won't be an issue. I'm already having serious labour anxiety after the issues I had last time so I could do without an added worry!

I got pregnant a month after leetz. Was a very uneventful pregnancy, despite him being an absolute whopper at birth. I'd try not to worry. The chances are that things will be completely fine.

I got pregnant six months after letz and biopsy and was fine and my baby was overdoes and nearly 11lb too

I'm 16w and had a scan to measure my cervix length on Monday because I have had a Lletz treatment. You may find that you're automatically offered a scan. Thankfully my cervix length was fine and I don't need to be seen again. I was told that if it had been short they'd probably re-scan me and basically monitor me every two weeks until 24 weeks. I think they avoid taking any action other than monitoring unless your cervix is very short.

I had LLETZ for Cin3 in 2015 too and got pregnant with DS 10 months later. All was well, nothing happened regarding the treatment.

I had LLETZ for CIN3 in dec 15 and I fell pregnant April 2016. I had a cervical scan around 18 weeks to check length/thickness as sometimes the procedure can remove part of cervix (very rare) and everything was fine. Carried to 40+4

If you are really worried though you can ask to be referred to the consultant - although the consultant then has to sign your care back over to the midwife unit if they are happy with how things are so if you did want to, you could be midwife led.

Please insist that your cervix is checked between 16-20 weeks. I suffer from Incompetent Cervix and sadly had a late miscarriage (though my cervix issues are nothing to do with any prior procedures so I was not being monitored). I had a stitch placed for my second pregnancy as a preventative measure.

I had lletz for CIN2 and fell pregnant nine months later, I had had spotting on and off in the first trimester, I saw a consultant at 18 weeks for something else, and mentioned the spotting. He saw the notes about the lletz and I went back three weeks later for a scan of my cervix. All looked ok, but when he checked again at 24 weeks my cervix had shortened by a cm, I was on progesterone pessaries for the remainder of the pregnancy and at 31 weeks signed off work as my cervix was very soft and DD engaged. It all sounds scary, but even though I started to dilate as soon as I stopped the pessaries at 36 weeks, I still went to 40+5. My main issue was that it was soft as well as having shortened.

Everyone is different though, I may have just been unlucky.

My midwife has just text me back. She's going to do a consultant referral so I'll get an appointment through the post for 16ish weeks.

I've had some early spotting which she knows about.

I'm happy now I have a referral, at least this way it can be monitored and on their radar.

Thanks for all the positive stories. Sorry for your loss @Blueroses99.

Hi Barry glad to hear you're getting checked. I was going to tell you to insist!

I've had LLETZ and cone biopsy procedures for cervical cancer and was told at the time that I'd definitely need a stitch when I was next pregnant. I had a scan at 9wks to check this, and stitch was placed at 13wks. Currently 24+4. Have been told I have barely any cervix remaining and I'm very high risk for preterm delivery. LLETZ and biopsies are very likely to cause cervical weakness so it definitely needs checking. If it's less than 25mm you will need to stitch. Hope this helps and I hope all is ok for you! X

Thank you Barry. Good news that you’re getting seen. Good luck.

You might also find some extra support over here: www.mumsnet.com/Talk/antenatal_clubs/2938323-the-short-cervix-club-cont

Good plan to flag it up now.

I had failure to progress with scarring and an EMCS. For some reason neither myself or the consultant worried about it when I was pregnant. Afterwards he said he'd never seen such a bad case of cervical stenosis. But I could probably go on a trampoline and the baby would stay in.

Planned cs for next baby.

Thank you so much for all your help and advice.

Does anyone know if they check cervix length as standard during the dating scan as I know this can be done from an abdominal scan? If so I may have a better idea where I stand from Thursday rather than having to wait in the dark until this consultant appointment comes through.

I'm not sure it can be done on an abdominal scan. But no, my pre-term clinic don't offer it that early.

No, cervical scans are not done as standard. In my most recent pregnancy I had a note from the consultant to have a cervical check at my 20 week scan (abdominal, then internal as they could see issues). Ask the midwife to add it to your notes for Thursday.

I don’t think I had a cervical scan at 12 weeks but I was already booked in for a stitch at 13+4 and had an early scan at EPU around 7 weeks where the cervix was measured.

Cervical issues don’t present until 16 weeks plus when the baby starts to get heavier so you have time.

Best case is that all is fine with you but good to be on top of it.

I had my cervix scan at 16w and then have been told to agree to an transvaginal one after my anomaly scan at 20 weeks - I'll have the usual abdominal and be offered an additional scan.

I had the same, LETZ for CIN 3.

I had cervical length scans at 22 weeks in both pregnancies with no concerns. Was under consultant led care for whole pregnancy.

Whilst there were no pregnancy issues when I went into labour I failed to fully dilate due to cervical scarring. This wasn't identified until the baby was stuck leading to a very last minute EMCS.

With second I was told I wasn't allowed to attempt a natural. Be prepared to ensure everyone in the delivery room is aware of the treatment as it might not necessarily be picked up on your notes (mine wasn't).

I had LLETZ and biopsy. At 16 weeks I received an internal scan to check the length of the cervix (which was fine). If it had been too short I'd have been referred for further scans with the option to have cerclage (cervix stitched shut) if necessary. Let your midwife know and get referred for a scan as an incompetent cervix can be disastrous.

elvis in my birth debrief after the EMCS the midwife very sternly told me to never attempt a natural birth (fine with me!).

Hi op.
I had stage 1a1 cervical cancer treated successfully with 2 lletz treatments in 2010. I had my first baby last year.
I was under a consultant through to 34 weeks pregnant but I had no issues.
I

Ooops! Posted too soon
I actually ended up going 9 days overdue so cervix was perfectly competent.
My labour resulted in forceps and episiotomy due to me having a large bleed but still none the wiser if lletz treatments had anything to do with that but obviously you know that can happen anyway!