LLETZ and pregnancy - advice

[Carabu1]

Hello ladies! I’m 8+2 with my first, and just seeking some advice from anyone who has experience of lletz treatment for abnormal cervical cells and pregnancy.

I had lletz for low grade changes about 3.5 years ago, can’t really remember them saying much about pregnancy but looking online it looks like the loss of cells can weaken the cervix and cause preterm labour. It also looks like there are some fixes for this (eg stitches). So my question is: when do you need to get this investigated (before 12 weeks? After?) and how did it go for you?

I am feeling a bit anxious as still haven’t got either a midwife date or a scan date so I have no idea when I’ll be able to ask someone and don’t want to miss the boat, as it were. Would consider going private if anyone has recommendations on private antenatal care.

Thanks ladies!

I had Lletz for CIN2 nine months before I fell pregnant, I had bleeding whenever we attempted intercourse plus some other issues which prompted an earlier appointment with the consultant. Was checked at 21 weeks and all looked ok, was checked again at 22/23/24 weeks and at 24 weeks my cervix had shortened by 1cm to 2.4, I was put on progesterone pessaries for the remainder of pregnancy, three times a day, and signed off at 32 weeks as DD was engaged and cervix very soft, but she hung in there until 40+5, hope that helps :)

@lumpydaisy we are getting into scientific debate probably more than needed on MN - but I find it a really interesting topic! I guess though a point from your first study is that it’s pretty small (97 women) and the CIN3 finding was thought maybe to relate to intrinsic changes in the cervix? OP had low grade change so for her that study is potentially quite reassuring. Your second one I can’t access well enough to really say. There’s another good English case control of 1300 women w PTB who had prev cervical biopsy or excision showing no increased risk with under 10mm excision (Castanon et al) and I believe there’s a meta analysis around as well. I do think it’s a complex topic and By no means have I done a full recent lit review - I definitely respect that you’re obviously well informed about this.
Full disclosure I am not in the UK and as you’re probably well aware different countries often can have different “spin” on research findings. I guess I just want to try and calm OP’s anxieties while supporting her to get the assessment and plan she needs :)

I’m not a smoker, never have been. I kind of resent the implication of that study that having had a lletz is my fault for smoking!!

This is all really helpful though, thank you. I’d rather be over cautious than too relaxed so will try and find out what was removed and get a scan. And fingers crossed it’ll be ok and they won’t have to do much! Thank you both for your advice - it really is very helpful!!

Hi - sorry that isn’t what I was trying to imply, no offense intended at all! More to convey that there are lots of reasons why LLETZ might be associated with preterm delivery which might not be related to the actual excision depth alone, and that might be why the study findings vary if they don’t adjust for those other factors. I realise we got into an unecessary level of detail though so I apologise for that - can’t resist a good academic discussion but the most important thing is that you get some decent guidance and the care you need. Sorry again! X

I'm really quite shocked at how inconsistent care is across the country, I had cin 3 reminded as I posted further up the conversation and when I asked about it was told nothing to worry about as long as you've only had it done the once and it wasn't an actual piece removed. Ow I see women having scans and being monitored for having even lower cin cells removed which would suggest a smaller amount and people getting stitches etc. Makes me feel I need to read ask about it now I'm in my second pregnancy xx

Let me know how you get on today @Carabu1

I’ve spoken to colposcopy who told me I had 8mm excised during Lletz.

I have just spoken to my midwife and was very upset with her tone. She said I was referred to a consultant who triaged my information and decided I didn’t meet their threshold. I was also told by midwife that NICE guidelines are “just guidelines” and that trusts have their own policies. She then suggested that my history of anxiety was the reason for me wanting the scan. I was very clear with her that I want to know what consultant thresholds are and how I was assessed, despite having 8mm removed there is no way to know how long my cervix is without the scan and that’s what I want and surely that will determine whether I need consultant lead care- she replied with “I don’t know how long my cervix is either”- cow!

Midwife gave me the number for triage team at maternity outpatient clinic and haven’t been able to get hold of them since. Looks like I will be having a private scan, just upset that I am being made to feel like I’m over reacting for wanting one scan to look into this issue

@TenThousandSpoons0 - sorry, didn’t mean you! More the study! This info is all so helpful, thank you!

@phiphi123 - you’re not overreacting!! I’m so sorry you’ve had such a horrible response. What a mean midwife! I would have been totally fuming. Unfortunately, I have found that with nhs care you have to arm yourself with info and make yourself a nuisance to get much to happen...! But reassuring to know you can just pay for a private scan if needed (not that you should have to!)

Spoke to hospital this morning and had a bit of a meltdown about the fact haven’t had any appts yet - she booked me in then and there. I’ve also asked to be consultant led as mod-high risk rather than midwife led and they are I think approving that today too. I guess the next battle will be getting the scan to check length booked but that’s next weeks problem, ha. Also called place where my lletz was done and they’re sending over all the files so I’ll hopefully be able to see how much was taken out etc. Feel in need of a stiff drink now....! Shame that’s off the cards for a while....!

@Carabu1good for you and hope you get your scan arranged by consultant. I am going for my private one tomorrow evening. £90 and 88mile round trip to pay for in petrol!!

@Phiphi123 so ridiculous, but good for you for deciding to just for it. I’m sure it’ll probably be fine but at least it will put your mind at rest! Really didn’t mean for this thread to scare anyone - but i have found all the info above so useful. Far more info than any dr has told me!

@Carabu1 Please keep us informed with how you get on. It's such a shame that we have to push for things like this but fingers crossed you will get the check ups you need

@Phiphi123 I'm so sorry that you're MW spoke to you like that it just isn't needed. It's a shame you have to pay for your own reassurance but at least it will hopefully put your mind at ease. Please let us know how you get on .

I had quite a lot of my cervix removed due to pre-cancer cells 9 years before I had my dd. I had all the measurements and scans done and was told everything was fine.

In labour however, we found the scar tissue of my cervix wouldn't stretch enough to allow full dilation. After many hours of them trying to stretch it by hand, both myself and dd getting in to severe difficulty and me begging for a cesarean, I eventually had an emergency cesarean.