Retrospective Evaluation of CO2 Laser Conization in Pregnant Women With Carcinoma In Situ or Microinvasive Carcinoma

Abstract

A number of studies have suggested the feasibility of laser conization in pregnant women but none were well-designed clinical trials in pregnant women with cervical intraepithelial neoplasia (CIN) or cervical cancer. This retrospective study investigated the long-term efficacy and safety of CO2 laser conization in pregnant women with CIN 3/carcinoma in situ (CIN3/CIS) or microinvasive carcinoma (MIC) of the uterine cervix. The participants in this review were 49 pregnant patients with biopsy-proven CIN3/CIS or MIC who were treated from 1994 to 2006. The median age of the women was 31 years (range: 22–39) and the median gestational was 17 (range: 7–33). Of the 49 women, 14 (28.6%) were in the first trimester, 33 (67.4%) in the second trimester, and 2 (4.0%) in the third. Following conization, the median blood loss was 78 mL (range: 10–797). Although 4 patients had a blood loss greater than 500 mL, no blood transfusion was required. The median operating time was 20 minute (range: 7–35) and the median length of cervix resected by conization was 13 mm (range: 5–23). There was no significant correlation between length of cervical resection and time of surgery. After examination of conization specimens, 1 CIN3/CIS patient (5.3%) was diagnosed with Federation of Gynecology and Obstetrics stage Ia2, and 3 MIC patients (15.8%) were Federation of Gynecology and Obstetrics stage Ib1. The outcome of pregnancy up to delivery was determined for a total of 35 patients: 26 (74.3%) had a normal full-term vaginal delivery. No conization-related obstetric complications occurred among the 8 patients (22.9%) who had a cesarean section and the 6 (17.1%) who delivered preterm. There was no clear relationship between obstetric complications and use of CO2 laser conization. These findings suggest that CO2 laser conization is a safe procedure for pregnant women provided that the length of cervical resection remains under 20 mm.