Thanks for posting this important info, Leanne. Perhaps specialists
should be recommending that women with abnormal PAPS become pregnant and
get a homebirth midwife. This article from the SOGC is good food for
thought. Gloria Lemay
SGO Press Release (c) 2002
Delivering by Vaginal Birth May Return Abnormal,
Pre-Cancerous Pap Smears to Normal
Medical researchers from the University of
California-Irvine and
the State University Hospital at Stony Brook, NY, have
determined that a vaginal delivery will result in an
increased
postpartum regression rate for pregnant women with
abnormal
antepartum cervical cytology. Their findings will be
presented at
the 29th Annual Meeting of the Society of Gynecologic
Oncologists.
Orlando, FL -- Women who undergo vaginal delivery
rather than
cesarean section may trigger regression of
pre-cancerous changes in the
cervix. This is one of the key conclusions reached by
seven medical
researchers in their new study, "The Effect of Route of
Delivery on
Regression of Abnormal Cervical Cytology in the
Postpartum Period."
The participants in this research effort were David
Ahdoot MD, Philip
DiSaia, MD, G. Scott Rose, MD, Devansu S. Tewari, MD,
Tom
Kurasaki, MS, and Nicole J, Nguyen, BA, all from the
University of
California-Irvine Medical Center, Orange, CA; and
Kristi M. Van
Nostrand, MD, from the State University Hospital at
Stony Brook,
Stony Brook, NY.
Dr. Ahdoot will represent his colleagues as he presents
the research
results on February 10, 1998, before the 29th Annual
Meeting of the
Society of Gynecologic Oncologists (SGO) being held at
the Walt
Disney World Dolphin Resort, Orlando, FL, February
7-11, 1998.
Background: Widespread use of the Papanicolaou (Pap)
smear has
resulted in a significant decline in cervical cancer
rates among women.
At the same time, the Pap smear has revealed an
increased incidence of
cervical intraepithelial neoplasia (CIN) (dysplasia or
pre-cancerous
changes.) An abnormal Pap smear is not an uncommon
finding in
pregnant women, since the peak incidence of CIN is in
the 20’s and
30’s, coinciding with the most common child-bearing
years.
Consequently, screening for the detection of carcinoma
of the uterine
cervix, with Pap smears, is a standard part of prenatal
care.
Previous research studies have found that pregnancy had
no effect on
CIN, whereas other medical reports noted regression of
cervical
dysplasia in the postpartum period. No study, however,
examined
whether the route of delivery (cesarean section or
vaginal delivery)
influenced the postpartum regression rates for cervical
dysplasia.
Methodology: Between 1990 and 1997, 446 women with
abnormal
cervical cytology at their initial prenatal visit were
identified at clinics at
the University of California-Irvine Medical Center and
State University
Hospital at Stony Brook, NY. Complete records were
available for 138
women; of that group, 109 (79%) delivered vaginally and
29 (21%)
delivered via cesarean section.
The initial antepartum, or prenatal, cytologic data on
all 138 women
were separated into three groups: atypical squamous
cells of determined
significance (ASCUS), low-grade squamous
intraepithelial lesions
(LGSIL) and the most severe abnormality, high-grade
squamous
intraepithelial lesions (HGSIL). Regression was defined
as either
complete normalization of Pap smear findings or
regression of HGSIL to
LGSIL.
Results: At their first antepartum visit, 26 women
presented with
ASCUS, 53 with LGSIL, and 59 with HGSIL.
The key results of the 59 women with HGSIL were:
47 women delivered vaginally and 12 by cesarean
section.
Cytologic regression was noted in 28 of the 47
(60%) women
who had delivered vaginally versus none of the
women who
delivered via cesarean section.
Of the 28 women who delivered vaginally and
exhibited cytologic
regression, only two had a recurrence of HGSIL at
follow-up
nine months after the date of delivery.
Of the 12 women with HGSIL who delivered via
cesarean
section, none entered the second stage of labor
(or reached full
cervical dilation). These women had persistent
dysplasia
postpartum and were subsequently treated with an
excision
procedure (or cervical conization).
Benefits: The research team suggests that vaginal
delivery offers a
number of benefits including an increased rate of
cytologic regression.
These benefits could be the result of enhanced
localized repair
mechanisms or stimulation of local immune factors.
Essentially, the
experience of vaginal birth delivery could trigger the
body’s natural
corrective response to the abnormal cells found in the
cervix before
birth.
Another consequence of this research effort might be
that physicians will
not automatically perform a cervical conization, after
birth, on women
who had an abnormal antepartum Pap smear and
subsequently delivered
vaginally. Now, a postpartum Pap smear may first be
performed to test
for spontaneous regression and thereby eliminate the
need for additional
medical intervention.
The Society of Gynecologic Oncologists (SGO) is a
professional society
of physicians who specialize in gynecologic oncology.
SGO is the only
U.S. based medical organization dedicated to the
prevention, detection
and cure of female cancers. Gynecologic oncologists are
cancer
specialists trained in all the effective forms of
treatment of gynecologic
cancers (surgery, radiation therapy, chemotherapy and
experimental
treatments) as well as the biology and pathology of
gynecologic cancers.
The organization is comprised primarily of gynecologic
oncologists as
well as medical oncologists, radiation therapists and
pathologists all of
whom have a primary professional commitment to the
treatment of
women with gynecologic malignancies including those of
the ovaries,
endometrium, uterus, cervix vagina, vulva and
trophoblastic disease.
- end -
Editor's Note: For a complete copy of the complete
manuscript or to
schedule an interview with Dr. Ahdoot contact Johanna
Spangenberg
(703) 527-7424.
leanne wynne wrote:
Source: http://www.medicinenet.com
Surgeries to Remove Precancerous Cervical Lesions Raise Obstetric Risks
By Steven Reinberg
HealthDay Reporter
THURSDAY, Feb. 9 (HealthDay News) -- Some of the most common methods
used to treat precancerous cells of the cervix may also greatly
increase risks for problem pregnancies, researchers report.
In recent years, cervical screening programs and treatment of
precancerous cells have dramatically reduced the incidence of cervical
cancer.
Using techniques such as cold knife or laser conization (where a
cone-shaped piece of cervical tissue is removed), laser ablation, or
loop electrosurgical excision procedure (cutting away cervical tissue
using a fine wire loop plus a low-energy current), doctors have been
able to successfully remove or destroy abnormal cells while preserving
cervical function, the researchers noted.
All these techniques are equally successful in preventing progression
to cervical cancer; however, their effect on future fertility and
pregnancy problems has been unclear.
The results of a new British study in the Feb. 11 issue of The Lancet
find that several of these techniques may be responsible for a variety
of problems during pregnancy.
"All the conservative excisional methods of treatment that remove part
of the cervix together with the transformation zone containing the
abnormal precancerous cells have more or less similar unfavorable
effects on future pregnancy, while laser ablation was not associated
with an increased risk of pregnancy-related morbidity," said lead
researcher Dr. Maria Kyrgiou, from the department of obstetrics and
gynecology at Royal Preston Hospital in London.
In the study, Kyrgiou and her colleagues analyzed data from 27
previous studies. They found that cold knife conization increased a
woman's risk of both preterm delivery and delivering a
low-birth-weight baby by two-and-a-half times, and tripled the risk of
Cesarean section, compared to women who did not have the procedure.
In addition, loop electrosurgical excision procedure (LEEP), the most
popular treatment, increased a woman's risk of both preterm delivery
and delivering a low-birth-weight infant by between 70 percent and 80
percent, and nearly tripled the risk for premature rupturing of the
cervical membranes, compared to women who did not undergo this
procedure. Laser conization had similar effects, but they were not as
severe, the researchers found.
Of all the methods, only laser ablation (laser removal of tissue) did
not increase the risk for pregnancy complications.
Kyrgiou said a woman needs to talk over her options with her doctor,
especially since invasive surgeries are not always required for
less-suspicious lesions.
"The treatment of precancerous lesions is necessary for the prevention
of cervical cancer," she said. "However, it should be performed when
it is necessary and appropriate by experienced clinicians, as a large
proportion of low grade/mild lesions will eventually regress back to
normal."
"Women should seek for detailed information on efficacy but also on
long-term pregnancy related morbidity before they consent," she added.
One expert thinks the study points to a serious problem that has been
overlooked by many physicians who have been too eager to adopt LEEP as
their method of choice.
"This epidemic of LEEP procedures is virtually as dangerous as the
cold knife procedure," said Dr. Steven R. Goldstein, a professor of
obstetrics and gynecology at New York University School of Medicine,
in New York City. "The abandonment of laser vaporization and
cryosurgery for early surgical disease is scary and dangerous," he added.
Currently, doctors are using LEEP because that's what they were
trained to do, Goldstein said. "In young women, you start cutting on
their cervix instead of freezing or vaporizing on the cervix and you
are going to see adverse obstetrical outcomes," he said. "Lasering or
freezing of the cervix doesn't have any of the risk."
Goldstein said doctors should think twice about using LEEP on young
women. "Think about whether you would want your daughter to have this
procedure before you do it," he said. "The pendulum needs to swing back."
For women, Goldstein's advice is to avoid LEEP during childbearing
years. "If you hear your doctor mention LEEP, perhaps you should
question him or her about the alternatives," he said. "In addition,
mild lesions don't always have to be treated, they can be watched," he
added.
SOURCES: Maria Kyrgiou, M.D., department of obstetrics and gynecology,
Royal Preston Hospital, London, England; Steven R. Goldstein, M.D.,
professor, obstetrics and gynecology, New York University School of
Medicine, New York City; Feb. 11, 2006, The Lancet
Copyright © 2006 ScoutNews LLC. All rights reserved.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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