Pregnancy after LLETZ

[89redballoons]

Hello - I'm a very long-time lurker here on mumsnet, but this is my first post. Sorry it's a bit of an essay...

Five and a half years ago, I had a LLETZ procedure to remove abnormal cells on my cervix, that were found after a smear test. The operation was under general anaesthetic and they removed CIN3 cells - this is the highest grade of abnormality before the cells actually get to cervical cancer. I don't know exactly how much of my cervix was removed. Thankfully, though, all my follow-up tests were fine in terms of HPV infection/abnormal cells, and I'm now back to having smears on a 3-yearly basis.

I'm now 17 weeks pregnant, which was a bit of a surprise as I have PCOS and a very irregular cycle, but very much a happy surprise! :) This is my first pregnancy.

I had my booking in appointment at 8 weeks and mentioned the LLETZ procedure to my midwife then. When I looked over my notes afterwards, I noticed she had written that I had had laser treatment on my cervix. That's not right: LLETZ stands for Large Loop Excision of the Transformation Zone, and I definitely didn't have laser treatment, as the operation and why they did an excision was explained to me at the time.

I had another midwife appointment last Friday and I pointed this out to my midwife. She said that these type of operations are usually done with a laser - which they're not - and anyway mine definitely wasn't. She amended my notes to say "excision" not "laser" but looked at me as if I'd gone mad when I asked if this might cause problems with my pregnancy. She said they would have only removed a tiny bit of cervix.

However, having done some reading online it seems the amount of cervix removed via LLETZ can vary, and that if they do remove more than 1.5cm (which looks rare but not that rare), this might put women who later get pregnant at risk of late miscarriage or premature birth, because the cervix stays too short or shortens too early in pregnancy. It also seems that in some places and some hospitals women who've had a LLETZ are under consultant care and their cervical length is monitored.

I'm now wondering if this is something I need to keep pushing with my midwife. Everything seems to be fine so far with my pregnancy, I've had no bleeding or any extreme pain, just a slightly achey back/abdomen but this might be normal for pregnancy (don't know as this is my first one).

There is a private ultrasound clinic very near me that offers cervical length scans, but I don't know how useful that would be on a one-off basis, as the kind of monitoring that other women get seems to be a series of scans, assessed by a specialist each time. And if I did have the scan privately and it looked like my cervix was too short, what then - would the clinic write to my NHS hospital and might I then be offered more monitoring or treatment?

If anyone has experience either with pregnancy after LLETZ, or with private ultrasound scans in general, I'd be really grateful to hear about it. I'm not too worried yet, just wondering if this is something I should be more worried about!

I have had LLETZ and at St Thomas (where I had my DD) they did extra monitoring scans to check the length of your cervix to keep an eye on it and determine if a cervical stitch would become necessary. It wasn’t needed In my case but it was reassuring that this was being monitored. I had a scan every 4 weeks I think ?

Hi, I had the same procedure as you, approx 12 years prior to my pregnancy, but have since had issues with ectropian so was worried may be an issue, need a stitch etc. I mentioned to midwife and then because in my notes it was discussed briefly with Dr I saw at time of 12 wk scan. At 20 wk scan they had arranged for me to have cervix length measured as an extra step. They confirmed it was fine and as a result no further monitoring was needed. If you could have the same done at your 20 wk scan would be no need to go private. Can your midwife arrange this via the hospital? Or can you speak separately with hospital to ensure it can be done?

Yes, that's what I thought. It looks like a bit of a lottery based on which hospital you're at as to whether you get monitored. I'm in a big city, but not London.

I'd happily pay for private scans every few weeks, but only if I knew that if they did find I needed treatment like a stitch, I could actually get it.

At my hospital you now get referred to preterm birth clinic as standard if you’ve had this procedure. I had cervix measured at 20 weeks. I have already had a pregnancy with no effects from the LLETZ, and it wasn’t done as standard then - I paid for a private scan. Is this an option?

I had a pregnancy about a year after my lletz. I was encouraged to try for a baby in my follow up appointment, and at no point were possible issues mentioned.

I told my midwife at booking in, and thought nothing of it. Then a few weeks later I was called in for an urgent consultant appointment. My notes had been reviewed, and I had lost a huge amount of my cervix - I can't remember the exact dimensions, but it was a lot. I needed an urgent scan straight away. There was a cut off for what they would consider a safe length of cervix, above which a cervical stitch wouldn't be needed. If my cervix had regenerated exceptionally fast, I wouldn't need the stitch. However, mathematically, it was unlikely.

I was supposed to be going on holiday the following week - the consultant said I couldn't go, unless the cervix was OK/stitched. I was only going to the Isle of Wight!

Anyway I got my scan, and I was just over the cervix safe length threshold. I was incredibly lucky - either I had a long cervix to begin with, or a very fast growing one.

I am still cross at that lletz follow up appointment. I should have been told that following pregnancies were likely to be high risk, not "go for it, babies are wonderful."

@Callmecordelia Blimey, that sounds scary. And also scary to think a similar thing could be lurking in my notes but doesn't seem like they're even getting reviewed!

Think I'm going to go for the private scan and also see if they can check at my 20 week scan. I'll actually be 21 weeks for my 20 week scan so that seems a long time to wait. Hopefully if the private scan does show my cervix is too short, I'll then be able to access treatment.

Make sure that the scan is the right type - in order to measure the cervix they had to use the thing they put in my vagina, not the jelly on the tummy type ultrasound.

Thanks, the private clinic is an Ultrasound Direct one and it says re the cervical length scan, "this ultrasound scan is recommended especially for women with a history of late miscarriage, multiple pregnancy or have previously had surgery on the cervix. It is performed trans-vaginally to obtain optimum clarity and results and can be part of a monitoring process for premature labour prevention."

So that sounds right, just seems a bit worrying that I have to arrange this myself. Maybe that's the NHS for you :( luckily the clinic is walking distance from my house and the private scan is relatively affordable.

That sounds exactly what you need. Book it.

Good luck.

Thank you everyone for your advice. I've booked the scan for this Sunday.

Hope all goes well for you. I had two LLETZ treatments a couple of years before my pregnancy. I didn't need a stitch, but I was given progesterone pessaries to use every night.

In the end, my cervix didn't dilate at all during labour due to the heavy scarring and I had an EMCS. So just be aware that as well as potential cervical incompetence, this is also a possible complication!

I had lletz 2.5 years ago and was CIN3 and had two pieces removed one 7.5mm & one 5.5mm so technically over the 1cm cut off two diff parts.
I had my first TVS scan at 16 weeks, then again at 20 weeks / 22 and 24 weeks. My
cervix has shortened but not enough to be hugely concerned but I have been prescribed progesterone pessaries daily since 24 weeks, I’ve got 4 more weeks of these left till I’m 34 weeks.
The scan on Sunday you will need to repeat as it will measure your cervix and then check the cervix doesn’t open but I’d totally push for an NHS referral! It’s ridiculous that you have to pay for it!!!

Almost identical to @Thursday, I had two LLETZ for CIN3, the latest 5yrs ago, with 3.7mm and 6.5mm cervical tissue excised. I was referred to a consultant because my MW was being over cautious. My consultant, and expert, was nonplussed reading my notes, I’m fit and healthy. But my TV scan results also indicated that I had perfectly acceptable cervical length at 16w and at 20w so I was discharged to MW-led care at my request.

LLETZ actually only very slightly increased your chances of compromised cervix in pregnancy. A cervix is designed to hold a baby in and infection out, so it is very often capable of regenerating to do its job very effectively and quickly.

Your medical team may have access to your gynae history and have had reassurance from your repeat and frequent smears that the cervix is in good health.

Most trusts I’ve worked in consider a consultant appt necessary in only multiple LLETZ procedures, and even then it’s precautionary, not diagnostic.

I had lletz for CIN2 9 months before I fell pregnant, an amount the size of my thumb nail was removed. I was referred to a consultant for a few things including the lletz, as I'd had some bleeding after intercourse they did a scan to check the length of my cervix, this was done at 21 weeks and measured 3.5cm, it was done again at 22 weeks then 24, again due to other issues and at 24 weeks my cervix then measured 2.4cm, at that point I had steroid injections and was given progesterone pessaries, I was signed off at 32 weeks as cervix was very soft and DD was engaged. Stopped the pessaries at 36 weeks, examined for something else and found to have dilated 1-2 cm at 37 weeks, DD stayed put until 40+5 even after a sweep at 40 where I was 3-4cm :) so all fine in the end.

Hi All,

Iv recently lost my baby girl at 22 + 5 weeks due to my water breaking early - im trying to figure out why this happened whilst an official investigation is going on at the hosp but i feel like i should have been monitored more closely by the hosp.

I mentioned at my booking in appt that id had lletz treatment aswell as inconclusive biopsies taken on my cervix and a polyp removed yet i was never referred to a consultant or offered a cervical scan to check the length of my cervix and i honestly feel like this is why iv my waters broke?! Can anyone advise if im right and although it wont bring my baby back should i persue in complaining about this? X

I'm so sorry for your loss

I still don't have an answer I'm afraid but in my experience they do monitor cervix length in this situation so I'd also be wondering why they didn't look at yours. Of course I have no idea if it would have made any difference in your situation. Can you speak to PALS about it in the first instance?

X

@Hayleylou89 I am so sorry for your loss. From researching when I was pregnant it seemed to differ from one trust to another. Where I am it was standard to refer to a consultant after just one lletz procedure and get a cervical length check, other people told me that theirs didn't refer unless they'd had two or three procedures. It was the same with support, I was given progesterone pessaries to use three times a day from 24 weeks up to 36 weeks, 400mg ones, again others I spoke to were only told to use one a day or not given them at all. Sorry I can't offer much help, and really hope that you get some answers.

I did speak to someone last year who had sadly had two losses at around twenty weeks, no previous lletz, but when they realised her cervix was incompetent they then gave her a cercelage stitch in her next two pregnancies and she carried both babies to term.

@annlee3817

Thanks so much for replying.

I need to now wait for a review to take place and ill be so disheartened if i should have received some form of additional scan or medication because of the treatments iv had on my cervix 😞 and if losing my baby could have been prevented by doing something so little ill be devastated 😢

@bad dirty cat

What is PALS sorry? X x

Patient Advice and Liaison Service.

@Hayleylou89 I had lletz to get rid of CIN3. Got pregnant, told my booking-in midwife, and nothing was said or done and I was classed as low risk pregnancy.

I lost my son at 20+0, almost 4 years ago now.

We took legal action but stopped short of going to court because our lawyers said we'd pay out more than we'd receive in compensation.

NHS trust admitted mistakes were made with my care but did not admit liability.

I still get upset now thinking about it all.

I'm sorry you lost your beautiful baby girl. The only hope I can offer is that because you have lost one child, subsequent pregnancies will be too-priority and closely monitored.

I've since gone on to have 2 DC.

@sandscript

Thank you for replying - I just know in my heart this is why my waters broke at 22 weeks and i know thats what the review will find - i dont understand how the hospital can not take responsibility though - I also mentioned about my lletz treatment aswell as my biopsies and polyp removal at booking yet nothing was mentioned about being monitored closer or a stitch, iv only found out about these things since losing the baby ... I guess I'm just going to have to wait until the review is done to ask the questions i need to ask. I know ill be watched closer next time but this really shouldn't of happened in the first place to anyone x x 😢