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Cervical Intraepithelial Neoplasia 2, 3 in Pregnancy: Time to Consider Loop Cone Excision in the First Trimester of Pregnancy?

Siegler, Efraim MD1; Amit, Amnon MD2; Lavie, Ofer MD1; Auslender, Ron MD1; Mackuli, Lena MD1; Weissman, Amir MD2

Journal of Lower Genital Tract Disease: April 2014 - Volume 18 - Issue 2 - p 162–168
doi: 10.1097/LGT.0b013e318299c0af

Objectives To report the outcome of patients diagnosed with cervical intraepithelial neoplasia 2, 3 (CIN 2, 3) during pregnancy, who were treated by large loop excision of the transformation zone (LLETZ) in the first trimester or were followed up conservatively and treated after delivery.

Methods Patients diagnosed with CIN 2, 3 during pregnancy who were treated with LLETZ or were conservatively followed up were included. Complications of the LLETZ, pathologic results, and pregnancy outcome of both groups were examined after delivery.

Results Thirty-one patients were included in the study. Eighteen were conservatively followed up and 13 underwent LLETZ during the first 14 weeks of pregnancy. Four patients (12.9%) in the study group were diagnosed with invasive cervical cancer. From women who underwent LLETZ, 9 patients continued their pregnancy, 7 of which had term normal deliveries and 2 had late preterm deliveries. No complications of severe bleeding or miscarriage were reported in any of the treated patients.

Conclusions Large loop excision of the transformation zone procedure in the first trimester of pregnancy is a safe procedure, with the advantage of treating definitively CIN 2, 3 lesions and preventing the devastating consequences of undiagnosed cervical cancer. We suggest that LLETZ should be performed more liberally in the first trimester of pregnancy.

Massive localized lymphedema, a recently described entity associated with obesity, can occur on the vulva.

1Colposcopy and Cervix Clinic, Department of Gynecology and Obstetrics, Carmel Medical Center; and 2Department of Gynecology and Obstetrics Rambam Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Reprint requests to: Efraim Siegler, MD, Carmel Medical Center, 7 Michal Street, Haifa, 34362 Israel. E-mail:

The authors have declared they have no conflicts of interest.

No funding was received for this work.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology