Pregnancy Outcome after Large Loop Excision of the Transformation Zone of Cervix / 대한산부인과학회잡지

OBJECTIVE: This study was performed to determine whether large loop excision of the transformation zone (LLETZ) affects the outcome of pregnancy after 20 weeks gestation. METHODS: In a retrospective case control study 20 women who had undergone large loop excision of the transformation zone and were subsequently delivered at Ilsin Christian Hospital were identified between 1991 and 2003. 40 controls were identified and matched for age and parity from women delivered immediately before and after index cases. Maternal factors were analyzed such as pregnancy gestation, use of oxytocin, analgesia, whether labor was induced, mode of delivery, length of labor, estimated blood loss and birth weight of previous delivery. Perinatal outcome measured fetal weight and admission to the neonatal unit. RESULTS: There was no significant difference between the women who had undergone LLETZ and the controls except women delivered after LLETZ had increased rate of emergency cesarean section and amount of blood loss. CONCLUSION: Previous studies investigating pregnancy outcome after LLETZ have been generally reassuring and this study also have no difference. However, in this study women who were delivered after LLETZ had slight increased rate of emergency cesarean section, this may be related to adverse obstetrical history (recurrent abortion, infertility etc.). However socioepidemiological factors were not controlled and the small number of case groups were included, so larger controlled studies will be necessary to confirm this findings.

Efficacy of Large Loop Excision of the Transformation Zone (LLETZ) in the Treatment of Cervical Intraepithelial Neoplasia / 대한산부인과학회잡지

OBJECTIVE: This study was performed to assess the efficacy of large loop excision of transformation (LLETZ) and to evaluate of clinicopathological factors with the probability of residual disease. METHODS: Retrospective study was performed in 56 patients treated with LLETZ from September, 1998 to October, 2001 in department of Obstetrics and Gynecology at Boramae Hospital. The patients underwent either immediate reoperation or monitoring with a cytologic smear and colposcopy. we investigate the significance of clinicopathological factors to predict residual disease after LLETZ. We used the Hybrid capture II test (Digene, USA) for presence of human papillomavirus (HPV). Residual disease was defined as histologic diagnosis of cervical intraepithelial neoplasia (CIN). RESULTS: Histologic assesment after LLETZ showed margin involvements in 28.6% (16/56) of cases but the residual lesion was only seen in 21.4% (12/56). There was no other serious complication. Positive margins was significantly associated with severity of lesion but not presence of HPV. Severity of lesion and margin involvements was significantly associated with residual disease (p<0.05). But age of patients and the presence of HPV was not significantly associated with residual disease. CONCLUSION: LLETZ is an effective, quick and reliable procedure on accurate diagnosis of cervical pathology and conservative treatment of CIN. Margin status and severity of lesions could be used to predict residual disease.