Complications and obstetric outcomes after laser conization during pregnancy.
OBJECTIVE
The purpose of the present study was to evaluate the efficacy of diagnostic laser conization and the obstetric outcomes of patients undergoing diagnostic laser conization during pregnancy.


METHODS
The study population consisted of a consecutive series of 47 patients who presented with histologically proven carcinoma in situ microinvasive carcinoma and were treated with laser conization during pregnancy.


RESULTS
Diagnostic laser conization was performed at 3-28 weeks (median, 13 weeks) of gestation. Intraoperative blood loss of > 500 ml was observed in two cases (4.3%); however, hemotransfusion was not required in either case. In the early postoperative period, two miscarriages due to preterm premature rupture of the membrane were observed. In the late postoperative period, one spontaneous abortion, three preterm deliveries, and one neonatal death were observed. All the poor obstetric outcomes were observed in the case of patients who underwent conization in the first trimester. The pathology report for the laser conization revealed that two patients (4.3%) had invasive carcinoma. Of the 47 patients, 29 (61.7%) had positive cervical margin, and 13 required postpartum surgical intervention. All patients treated were disease-free at the time of the subsequent follow-up.


CONCLUSIONS
The results of the present study suggest that laser conization in pregnant patients is feasible and is comparable to cold-knife conization and loop electrosurgical excision procedures with regard to the rates of complication and obstetric outcomes. Furthermore, they indicate that the optimal time for conization is probably the second trimester.
Seki
N
N
Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Kodama
J
J
Kusumoto
T
T
Nakamura
K
K
Hongo
A
A
Hiramatsu
Y
Y
D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D016063:Blood Loss, Surgical; D019092:Conization / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D007752:Obstetric Labor, Premature / Q000209:etiology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*