Pregnancy after LLETZ

[alp]

Hi - I am 11 weeks pregnant and had a loop cone biopsy back in July.

I know that one of the 'side effects' is premature labour at around 37weeks but would like to know if anyone else has experience of this and what expect.

My GP has told me to stop any high impact exercise (I used to run 3 times a week) where as my midwife didn't see it as a problem to carry on as usual.

I have a consultants appointment in 3 weeks but other than that and with two conflicting points of view, I don't know what to think!

Mumsnet Jury? Can you help?!

hi alp, ive no experience of this as this is my first pregnancy but im interested to know what others have to say. im 20 +3 weeks with twins and had lletz in jan 08, i know most twins are born at 37 weeks as it is considered full term for twins but this has me wondering could they arrive even earlier because of lletz.

No experience but my DD was born at 36 weeks, happy, healthy and no probs. She's 19 months now and completely fine developmentally, so it shouldn't be the end of the world if you do deliver early

Just to give you a different point of view. I have had 2 LETZ treatments, nov 04 and march 05. I had quite big chunks taken out and when I was in labour with ds in nov 06 (at 37 weeks) they realised my cervix was just scar tissue and it would not dilate at all even after a strong 12 hiur labour, so I had an em cs.

I think mine was an extreme case but having a LETZ doesn't mean you will have a premature birth or that the cervix won't be strong enough to hold a pregnancy. My consultant said I could jump on a trampoline during my second pregnancy and the baby would stay in.

I understand that most women don't have any problems following LETZ.

OK well thanks for the replies...

Valz - If you had a lletz and are having twins and nothing has been mentioned then I guess there is nothing to worry about! Did you have a cone biopsy? Perhaps its the extent of the surgery plays a part. BTW my friend had twins and was overdue with them so the same old saying of eveyone is different comes out again!

Mumnosbest - My DD was born on her due date so I have no experience of early or late babies!

i've had 3 lletz and have an incompetant cervix as a result. I've had 2 prems 32 & 27 weeks. I think most women are fine and my cervix has been especially butchered over the years but it is something worth watching even if the only extra thing they do is check your cervcal length at your scans.

I've had several, plus a cone biopsy and I did have a short cervix, however the hospital just monitored me with weekly scans until 26 weeks - all was ok but I did have to rest etc. If it had of gon too short (below 15mm for any length of time) they might have put in a stitch but generally doctors will resist treatment until absolutely necessary as it can do more harm - there is a 5-10% rick of miscarriage with a stich.
New advice seems to be that a cervix is short/incompetent only if below 15mm - old advice was below 25.

Anyway, I'm now nearly 38 weeks with a cervix that has never been longer than 25mm - no signs yet, but I am glad I had scans etc throughout and was regularly monitored. Ask for an internal scan to check your cervical length - and remember that for the majority of women they can go right through to full term with no problems and then have an normal delivery. Like Worzel I'm mainly scar tissue so booked in for a CS, however doctor has pointed out that is due to the cone biopsy, not the LLETZ.

Good luck

Perhaps I am naive to think that a lletz and cone biopsy are/were the same.

Thanks for the comments and advice - It is the not knowing what to expect that is most annoying especially as the GP and Midwife have such differing opinions.

If I know what the 'usual' care is for a some having had a cone biopsy then at least I can speak to the consultant with some knowledge and confidence.

A cone biopsy is done under general anesthetic so day in hospital, proper op etc.
They cut a section out of the cervix and stitch it back together - usually about a third of the cervix is removed, so quite a lot different to a LLETZ which is more like a deep exfoliation (according to my gynecologist)! LLETZ are seen as relatively minor - although having had them I still think pretty uncomfortable!

ALP - meant to say that yes, a cone biopsy is more severe than a LLETZ, so yes is worth questioning your treratment - last post sounded a bit brisk , sorry - lack of sleep! I would def ask for an internal scan, and don't be fobbed off by talk of lletz, a cone biopsy is a bigger op.

Thanks for the guidance and the post didn't seem abrupt at all!

Yes it was a loop cone biopsy under a general that I had. Now armed with more information I feel much better prepared when I see the consultant.

I am still intrigued to the blasee (sp?!) nature of the midwife though, she even wrote 'X is worried about cone biopsy' in my notes.Not that I want to be wrapped in cotton wool I would just like her to understand my worry or at least answer my questions!

Hi alp - I haven't had a cone biopsy but I had LLETZ twice and am now 36+5 and no sign of baby coming early. I had a scan at around 17 weeks to measure the length of my cervix and make sure it wasn't funneling and then they were happy to leave it at that. Midwife at my last appointment said that sometimes people who have had LLETZ have shorter labours as the cervix can dilate more quickly - so you never know, there might be a silver lining! Good luck chatting to consultant... and fingers crossed he/she tells you it is fine to carry on running. I'm a runner as well and carried on running until about 22 weeks - would have gone mad if had had to stop! x

Also meant to say that a cone biopsy can mean you could need a CS, but again not in every case, it just depends on how much was taken. I think your doctor should be able to tell just by looking during an internal, the scar tissue should be easy to see. It can indicate you might need a CS, but they won't tell you until about 20 weeks anyway.
But natural births are possible, and if there is not much scar tissue the doctor can 'stretch' it during labour - I think that means they can break it, and it will reheal, and I guess that many women will tear or be cut during labour so again a cone biopsy isn't necessarily an indicator of needing anything other than a normal labour. But it might be worth asking about so you can get all the facts and make a decision.

To be honest the thought of a CS was never a thought that had entered my mind - I was always thinking more of the cervix being weak due to the cone biopsy and concerned that the baby might be more prone to coming early rather than not being able to come out at all, IYKWIM!

Bicnod - I am going mad at not being able to run! And eating the same amount as if I was still training like a maniac!

yep - thats also possible, they can come out quick and early or you can not dilate and it can take longer! Or it can all be perfectly normal and the cone biopsy won't mean anything!
Have fun when you chat to your doctor!

Hi!
I have recently had a miscarriage at 18 weeks. They think it is due to a loop cone biopsy I had done back in 2000, and infection getting through because of my cervix not being quite closed.
I really hope that all goes well for you. I am so glad to hear that you have an appointment with the consultant.
My midwife missed the fact that my history might cause a problem with the pregnancy.
My consultant has told me that if I get pregnant again they will do an early scan and an internal exam. They can then take a stitch and also give progesterone (which helps you to keep the baby - it is naturally produced by the body during pregnancy but an ongoing boost of this can help) and also antibiotics (if needed). The stitch would come out towards the end of the pregnancy. There is a chance that the baby may come slightly early but it would apparently be nothing to worry about by that stage.
I am not sure about the exercise side of things but I hope that this is a help anyway.

Littlei - thanks for your post. It has been the midwife's casual approach that prompted me to post about this in the first place. And hearing your story makes those concerns even more real.

I had another dating scan today - at the previous scan they changed my dates so I needed to go back - baby was fine all was OK and I have a consultant appointment in 10days so I will start writing my list of questions!

Hi alp - I am so glad if my post helped. I didn't want to scare you but equally felt the need to let you know what happened to me so that you can make sure that you avoid a similar thing.
It is scarey how off-hand some midwives are.
Make sure the consultant gives you an internal examination. I went to hospital twice. First time I had, had a leak of amniotic fluid and the second time (3 days later) I was having contractions and went on to have the miscarriage. On my first visit the junior doctor attending me said that my cervix was closed but the consultant has later told me that there is no way that they can tell this simply by looking.
I am so glad that everything went well with the scan. I hope that all goes well at your meeting with the consultant.
Good luck with everything!!

Hi
I wonder if you can help. I had a LLETZ back in 2002. I have no idea how much of my cervix was removed and am very worried about effects on this, my first pregnancy.
I am now 14 weeks +2 pregnant. When I mentioned the LLETZ to my doctor, she dismissed it and said she could give me more to worry about. I raised it with my midwife at the 12 week scan and she said she would try to refer me to a consultant for a cervical scan but I have heard nothing since. Does anyone know when you should have the first cervical scan?
Thanks so much for any info.

Hi - My update might help.

I saw my consultant at 14 weeks - and he said that he wouldn't do an internal scan until 22 weeks as doing it earlier will then run the risk of 'over treating' which can cause complications in itself. He also said 95% of cases require no treatment and have no effect at all.

Although I don't have all the answers I wanted at the time, speaking to him has allowed me to feel a bit more relaxed about it all.

Do take confidence from the other posters who talk about the LLETZ procedure being relatively minor and are/have had straight forward pregnancies.

Oh and congratulations!

Thanks so much. Have now been given a date for a cervical scan at 16 weeks and 20 weeks.

Congratulations to you too, and good luck.

Hi - I am about to have treatment for an abnormal smear and am very worried of pre term labour in the future. Do you know if laser treatment reduces the risk compared to LLETZ?

Thank you!

In 2001 I had LLETZ treatment and as never told of the risk of premature delivery, In 2006 I became pregnant with my third child and had the baby at 31 wks. I am pregnant again every though I had a contraception rod in my arm (another story). At my first Consultant appointment I asked of the risk of having another premature baby. I was told that the risk was very high due to my history of already having a preterm baby and the LLETZ procedure. "Shock" after two and a half year I had found the reason why I had a premature baby, no-one had thought to tell me of this gem of knowledge.
When I got home I search online for my own answers. This is when I found mumsnet and the wealth of info from all you lady's who have posted on this site. I am now armed with knowledge and can go back and ask for a cervical scan and to be able to talk to others about their experiences

Hey i am thinking of trying for another baby but have been told that there is a risk of having a pre-term baby and risk of miscarraige! I am having the ltez treatment as i have had these cell changes for over 4 years now and i have had it cauterised befor aswell. I really would like to have a child now but my husband isnt so sure! lol i am trying to explain that at the mo i dont have those risks if we tried now and that if we wait till after the treatment i could be worrying more with the risks! I could then have the treatment done in a yr after the baby, i only would like one more child so it seems silly to have the treatment and have the worry. I only have cin 1 so very early stages and cant see it changing over the next year, what does anyonelse think?