New Zealander Wonders: Does A Cervical Cone Biopsy (LEEP) Lead To An Incompetent Cervix During Pregnancy?

Question:

Hi Doctor,

I'm a 33 year old woman from New Zealand. I recently had a missed miscarriage and D&C (22nd Nov 2009) , then one month later I had another D&C due to infection and retained product. I also had a D&C at age 17 years and a termination at 29 years. I also had a LETZ at 25 years. The doctor has advised me to wait 6 months before getting pregnant again to help my cervix strengthen. He is also saying that I will most probably have an incompetent cervix due to all surgery and the only thing they can do is monitor me during my pregnancy. Is there anything I can do before my pregnancy to help? Are there any tests to see how strong my cervix is?

Will waiting 6 months strengthen my cervix? Do you know of anyone else who has had this many D&C's and a LETZ and still been able to carry to term?

Thanks you so much! I haven't been able to find answers to my questions and I'm feeling very anxious.

Answer:

Hello J. from New Zealand,

Many women have multiple miscarriages requiring D&C, or have multiple abortions. They are not necessarily at increased risk of incompetent cervix. They are at increased risk of uterine adhesions from the multiple D&C's. The risk of incompetent cervix comes from the LETZ procedure because a portion of the cervix is removed. (Briefly: the LETZ procedure removes the entire abnormal area of your cervix with a hot wire loop. The tissue is then sent to Pathology for diagnosis. Some doctors, myself included, refer to this procedure as LEEP-"Loop electro-surgical excision procedure"). That is NOT to say that you are definitely going to have incompetent cervix, only that SOME women that have had cervical cone biopsies or LETZ/LEEP seem to have an increased incidence of cervical incompetence.

I have been doing LEEP for a long time and have never had this problem with my patients. It is a procedure I excel at and enjoy doing. It probably depends on how deep of a cut the Physician makes. There is no way to predict who will have incompetent cervix or not. In some cases, where the cervix is found to be shortened or there is a previous history of incompetent cervix, the doctor will do a cervical cerclage (put a stitch in the cervix), in advance. I would not recommend that in your case. For now, your Ob doctor just needs to keep an eye on things by doing serial ultrasounds to check the cervical length.

In terms of waiting 6 months. There is no reason to do that. There is no such thing as "strengthening the cervix or waiting for the cervix to strengthen". The cervix will be repaired and ready within 6 weeks.

Good Luck,

Edward J. Ramirez, M.D., F.A.C.O.G.

Follow-Up Reply:

Thank you so much, Dr.Ramirez,

You have made me feel much better, I had been unable to find any info on this (apart from terrible stories from google) and have been worrying myself sick about it. I will pin your email to the wall and remind myself when I get anxious! Again, thank you so much! J.