title: Cervical intraepithelial neoplasia 2, 3 in pregnancy: time to consider loop cone excision in the first trimester of pregnancy?
abstract: OBJECTIVE
  To report the outcome of patients diagnosed with cervical intraepithelial neoplasia 2, 3 (CIN 2, 3) during pregnancy, who were treated by large loop excision of the transformation zone (LLETZ) in the first trimester or were followed up conservatively and treated after delivery.
  
  
  METHODS
  Patients diagnosed with CIN 2, 3 during pregnancy who were treated with LLETZ or were conservatively followed up were included. Complications of the LLETZ, pathologic results, and pregnancy outcome of both groups were examined after delivery.
  
  
  RESULTS
  Thirty-one patients were included in the study. Eighteen were conservatively followed up and 13 underwent LLETZ during the first 14 weeks of pregnancy. Four patients (12.9%) in the study group were diagnosed with invasive cervical cancer. From women who underwent LLETZ, 9 patients continued their pregnancy, 7 of which had term normal deliveries and 2 had late preterm deliveries. No complications of severe bleeding or miscarriage were reported in any of the treated patients.
  
  
  CONCLUSIONS
  Large loop excision of the transformation zone procedure in the first trimester of pregnancy is a safe procedure, with the advantage of treating definitively CIN 2, 3 lesions and preventing the devastating consequences of undiagnosed cervical cancer. We suggest that LLETZ should be performed more liberally in the first trimester of pregnancy.
authors.affiliation: 1Colposcopy and Cervix Clinic, Department of Gynecology and Obstetrics, Carmel Medical Center; and 2Department of Gynecology and Obstetrics Rambam Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Efraim
authors.initials: E
authors.lastname: Siegler
authors.forename: Amnon
authors.initials: A
authors.lastname: Amit
authors.forename: Ofer
authors.initials: O
authors.lastname: Lavie
authors.forename: Ron
authors.initials: R
authors.lastname: Auslender
authors.forename: Lena
authors.initials: L
authors.lastname: Mackuli
authors.forename: Amir
authors.initials: A
authors.lastname: Weissman
mesh_terms: D000328:Adult; D015331:Cohort Studies; D019092:Conization / Q000379:methods*; D005260:Female; D006801:Humans; D011181:Postnatal Care / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011295:Prenatal Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery