Abnormal pap smear result

Question 1

Explanation when woman receives HSIL result

Answer 1

1. It is not cancer.
2. Indication for further investigation with surgery/follow up
3. Pap is screening test, not diagnosis
4. Contraception until after the surgery
5. Does not affect ability to fall pregnant
6. Close monitoring if pregnant, increased risk of miscarriage, preterm
7. Prior to conception->daily folic acid, rubella screen
8. HSIL may progress to cancer
9. Make appointment with gynae to colposcopy clinic
10. Visualise cervix under microscope, take a biopsy
11. Get results->LLETZ recommended
12. Local/general anaesthesia
13. Visualise again and remove tissue
14. May required cone biopsy if discrepancy, cannot visualise all, microinvasion
15. Discharge for 7-10 days

Question 2

Risks of the procedure

Answer 2

Rarely ++bleeding needing hospitalisation and diathermy
Bleeding from infection->treat with amoxicillin
Injury to bladder/bowel
Cervical stenosis->dysmenorrhea, amenorrhea, interferes with ability to become pregnant

Question 3

When should she try to become pregnant

Answer 3

Following procedure will have repeat pap smear and colposcopy at 3 months
If negative will have f/u at 6 and 12 months, including HPV testing
Should wait until negative check up at 6 months.

Question 4

Treatment affect on falling pregnant and continuing pregnancy

Answer 4

Following->cervic heals and develops new SCJ, in majority of cases no effect on fertility. Very ocasionally with LLETZ/cone biopsy cervical stenosis may develop and dilation of cervix may be needed.
May +incidence of miscarriage and preterm, repeated may shorten cervix/cervical incompetence.
Specialist services, and possible suturing of cervix would be required.