MANAGEMENT OF CERVICAL INTRAEPITHELIAL NEOPLASIA DURING PREGNANCY WITH LOOP EXCISION

Objective: Management of severe cervical dysplasia/possible microinvas ive carcinoma during pregnancy is frequently associated with significa nt morbidity. The purpose of this study is to determine the efficacy o f LOOP excision performed during pregnancy, and also to record the nat ure and frequency of complications of the procedure. Methods: Twenty w omen underwent LOOP excision during pregnancy. The gestational age ran ge was 8-34 weeks. Data concerning indications, complications, and his topathologic results were recorded. Results: Fourteen of 20 (70%) had dysplastic changes in the LOOP specimen. Eight of 14 (57%) had involve d margins. Nine of 19 (47%) had residual dysplasia 3 months post-partu m, including 3 patients whose initial LOOP specimens were negative for dysplasia. Significant morbidity included 3 preterm births, 2 patient s who required blood transfusion following LOOP, and 1 unexplained int rauterine fetal demise documented 4 weeks post-LOOP. The gestational a ge range of those patients who had significant morbidity was 27-34 wee ks. Conclusions: LOOP excision of the cervix during pregnancy does not consistently produce diagnostic specimens and is associated with a si gnificant rate of residual disease. Morbidity appears similar to that of cone biopsy during pregnancy and occurs primarily when the procedur e is performed in the third trimester. Until refinements in technique occur, LOOP excision during pregnancy should be reserved for limited i ndications. (C) 1997 Academic Press