No abstract

Since its introduction in1989, large loop excision of transformation zone (LLETZ) has been the most popular method used for the treatment of cervical intra-epithelial neoplasia (CIN). It has advantages like being performed in short duration, outpatient procedure, low cost, good compliance, simplicity and easier learning method. There is a very good evidence to suggest that LLETZ has low morbidity and at the same time is successful at eradicating intraepithelial lesions and preventing invasive cervical cancer. But the data available with regard to future pregnancy outcomes are very conflicting. Some studies have shown poor obstetric outcome after LLETZ, which involved preterm delivery, PPROM and low birth-weight. Whereas, most studies show that LLETZ has no adverse effects on pregnancy outcomes. Therefore, the authors performed this retrospective study in a district general hospital. 63 women who underwent LLETZ procedure and subsequently delivered were selected randomly. The labour ward statistics for the similar period was used as control. Our study concluded that the caesarean section rate in the study group was lesser than in general population. Preterm delivery rate was not significantly higher than the general population (10% vs 8%). Although there were significant women who smoked in the study group, the incidence of low birth-weight at term was still less (3% vs 4%). It was obvious from our study that LLETZ does not appear to exert an independent adverse effect on subsequent pregnancy and neonatal outcomes. However, more studies should be performed before adopting LLETZ liberally for treating women with abnormal cervical smears.

The Department of Health has recommended that 'Routine Antenatal Anti-D Prophylaxis' (RAADP) should be offered to all non-sensitised Rhesus D (RhD)-negative pregnant women at 28 and 34 weeks of gestation. 1 The difference between RAADP and prophylactic anti-D given because of likely sensitisation event should be clearly explained. 1 The Royal College of Gynaecologists has recommended the administration of additional antenatal prophylaxis following sensitisation events and postnatal prophylaxis to all non-sensitised RhD-negative women with RhD-positive babies. 2 This retrospective study aimed to fi nd out whether the management of Rhesus D-negative women during pregnancy was adhered to in accordance to the NICE and Green-top guidelines. Thirty-one cases of non-sensitised RhD-negative pregnant women selected randomly between January 2006 and September 2007. Our results showed that 93% of women had RAADP and 96% of women had additional antenatal anti-D prophylaxis following sensitisation events. Sixteen per cent of women who declined RAADP received postnatal prophylaxis without documentation of their consent. The reason[s] for their refusal to administer RAADP but accepted postnatal prophylaxis was not documented. Our study showed that majority of women received RAADP and additional antenatal anti-D prophylaxis. Whether women truly understood the actual implication of refusal of RAADP was unclear. Improvement in documentation regarding the reasons for declining antenatal prophylaxis might help the improvement in uptake of anti-D prophylaxis.