Cesarean Hysterectomy Revisited

Loop-cone cerclage in pregnancy: a 5-year review

OBJECTIVE

The purpose of this study was to evaluate the efficacy and outcomes of patients undergoing conization utilizing a technique of loop-cone cerclage when a diagnostic cone biopsy was required in pregnancy.

METHODS

All loop conizations between 1997 and 2001 were reviewed; 15 patients were identified who underwent cone- cerclage with 13 medical records completely available for review. Abstracted data included age, parity, pap smears prior to and during pregnancy, and histology obtained during colposcopy. The operative time for the procedure, estimated blood loss, complications, pathology of loop specimen, and pregnancy outcomes were recorded.

RESULTS

Thirteen charts were available for complete review. The mean operating time was 22 min; 11 patients had less than 50 cc blood loss and two patients had a 250 cc blood loss. The median age was 26.5, average parity was 2, and mean gestational age was 24.1 weeks. Six patients had abnormal pap smears prior to pregnancy, one woman had previously undergone colposcopy, and there was no documentation of previous pap smears in six patients. During pregnancy, on pap smear, nine patients had HSIL, three patients had ASCUS/LSIL, and one patient had adenocarcinoma. Thirteen patients underwent colposcopy and biopsy; eight patients had the question of invasive disease, five patients had endocervical glandular involvement with carcinoma in situ, which were the indications for conization. There were no intraoperative or late postoperative complications. All patients delivered at term.

CONCLUSIONS

While the need for conization during pregnancy is rare, there are indications when it is necessary. Loop-cone cerclage is a safe method for performing diagnostic and therapeutic conization during pregnancy.