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  • 1
    Electronic Resource
    Electronic Resource
    Follow up after LLETZ: could schedules be modified according to risk of recurrence? (2001)
    Oxford, UK : Blackwell Science Ltd
    BJOG 108 (2001), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objectives To document the pattern of recurrence of disease following large loop excision of the transformation zone (LLETZ) to identify a low risk group of women who might benefit from less intensive cytological surveillance.Design Analysis of prospectively collected information with retrospective review of follow up smears.Population Three thousand, five hundred and sixty women who underwent LLETZ (median age 31 years; IQR 12 years).Setting Colposcopy clinic at Northern Gynaecological Oncology Centre, Gateshead.Methods Women treated with LLETZ from 1988 to 1995 were reviewed. Information on the pathology from LLETZ was collected prospectively and information on the subsequent smears was obtained from the family health authorities.Results Invasive cancer was detected on the original LLETZ in 134 women who were excluded from the study. Of the remaining 3426 women, histology of LLETZ showed high grade CIN (II and III) in 2371 (69%). At least one follow up smear was undertaken in 3385 women (99%). This constituted 9765 women years of follow up with a mean duration of 35 months. Four hundred and seventeen women (12.2%) had a dyskaryotic follow up smear. Incomplete excision of the lesion and an age of ≥ 50 years at the time of the LLETZ were associated with an increased risk of recurrent CIN. Based on these risk factors the study group was divided into three risk groups: 1. women aged 〈 50 with no disease at the margins (n=1680); 2. women aged ≥ 50 with disease at the margins (n=93); and 3. women aged 〈 50 with positive margins, or aged ≥ 50 with negative margins (n=1653). The cumulative survival without recurrent CIN at five years for these groups were 92%, 57% and 86%, respectively.Conclusion Women aged ≥ 50 with CIN at the margins of excision constituted a small minority high risk group (3%). Consideration should be given to repeat treatment of these women rather than surveillance. Women aged 〈 50 with complete excision of low grade CIN comprised 51% of the study group. These women were at low risk of recurrent CIN and might benefit from less intensive cytological surveillance following LLETZ.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.2001.00240.x
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  • 2
    Electronic Resource
    Electronic Resource
    Fertility and pregnancy outcome following large loop excision of the cervical transformation zone (1995)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 102 (1995), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To determine if large loop excision of the transformation zone affects subsequent fertility and pregnancy outcome.Design A case-control study.Setting A teaching hospital serving a regional population.Subjects One thousand women who had undergone large loop excision of the transformation zone (LLETZ) for the treatment of cervical intraepithelial neoplasia (CIN) between 1989 and 1991. Two controls were matched for each of the 149 women who had a singleton pregnancy progressing beyond 20 weeks of gestation following treatment, with regard to age, parity, height, husband's or partner's social class and smoking habits to account for common independent risk factors for adverse obstetric outcome and cervical intraepithelial neoplasia.Main outcome measures Intention to conceive, number of pregnancies, gestation, low birthweight, mean birthweight, mode of delivery, and duration of labour.Results Out of a cohort of 1000 women who underwent LLETZ for the treatment of CIN, 653 women replied to a postal questionnaire. When asked up to 54 months after treatment, 130 women (19.9%) had become pregnant and 47 (7.2%) had tried to become pregnant. A total of 199 pregnancies from 178 women was identified from the cohort of women.For the 149 women from the case cohort, the mean birthweight was 3380 g compared with 3373 g in the control group (P= 0.88). The incidence of low birthweight in pregnancies progressing to at least 37 weeks of gestation was 3.1% in the treated group, compared with 3.2% in the control group (P= 098). Following LLETZ, 94% of deliveries were preterm (〈 37 weeks of gestation), compared with 50% in the control group (P= 0.12). There was no significant difference in mean gestation, mode of delivery, indication for caesarean section or duration of labour between the women who had undergone LLETZ and the controls.Conclusion When socio-epidemiological factors associated with the development of cervical intraepithelial neoplasia are controlled for, LLETZ does not appear to exert an independent adverse effect on subsequent pregnancy outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1995.tb11319.x
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    The miscarriage clinic: an audit of the first year (1991)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 98 (1991), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary. We preview the results of the first year in a Miscarriage Clinic set up in 1989 in an effort to improve the support and counselling of women who have a miscarriage. Of 381 patients referred, 79% attended. The only statistically significant difference between the women who attended and those who did not attend was in the proportion of women who had planned their pregnancies (65% versus 33%, P〈0.01). Of the 300 patients who attended, 4% reported no grief reaction; 75% experienced a reaction which had resolved within one month and 21% experienced a reaction which had not resolved. No factor was identified which could predict the duration of the grief reaction. This audit demonstrates that there is a strong demand and need for this service for couples who experience a miscarriage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1991.tb13398.x
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    Paper (German National Licenses)
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