Lasers in Medical Science

, Volume 10, Issue 2, pp 131–136 | Cite as

Minimal laser conization during pregnancy

  • Zoltán Békássy
  • Constantin S. Iosif
  • Birger Åstedt
Original Articles


The objective of this study was to evaluate a minimal laser conization procedure during pregnancy for safe diagnosis and treatment of carcinoma in situ. This was a clinical prospective study in a University Hospital. Seventy-five pregnant women selected on the basis of a cervical smear showing carcinoma in situ or dysplasia, or an extensive picture confirmed by colposcopy, were referred for minimal conization procedure. A free-hand minimal conization procedure using a carbon dioxide (CO2) laser was performed in ambulant care under local anaesthesia. The minimal conization procedure is defined as the removal of a 7.0 mm high, slightly conical tissue specimen from the uterine cervix containing the entire transformation zone. After the cone specimen was taken, routine cervical curettage was also performed. There were no complications attributable to the conization procedure and no adverse effects either during pregnancy or at delivery. Histopathological examination of the cone specimens from 75 patients revealed carcinoma in situ or dysplasia in 65 cases. More advanced malignancy was found in 10 cases; micro-invasive carcinoma stage 1A (n = 7) or stage 1B (n = 3). The minimal conization procedure with CO2 laser during pregnancy enables safe diagnosis of carcinoma in situ selected by cytology and colposcopy. It also proved useful for diagnosis and treatment of stage 1A or stage 1B carcinoma, enabling pregnancy to be preserved and radical cancer treatment to be postponed until delivery.

Key words

Carbon dioxide laser Conization Pregnancy Carcinoma in situ Invasive carcinoma of cervix 


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  1. 1.
    Beecham CT, Andros GJ. Cervical conization in pregnancy.Obstet Gynecol 1960,16:521–6Google Scholar
  2. 2.
    Rogers R, Hutchison WJ. The Impact of the suspicious Papanicolau smear on pregnancy.Am J Obstet Gynecol 1967,98:488–96Google Scholar
  3. 3.
    Averette HE, Nasser N, Yankow SL, Little WA. Cervical conization in pregnancy.Am J Obstet Gynecol 1970,106:543–9Google Scholar
  4. 4.
    Sedlacek TV. Cervical intraepithelial neoplasia. In: García C-R, Mikuta JJ, Rosenblus NG (eds)Current Therapy in Surgical Gynecology. Toronto, Philadelphia: B C Decker Inc, 1987:190–1Google Scholar
  5. 5.
    Kiguchi K, Bibbo M, Hasegawa T et al. Dysplasia during pregnancy. A cytologic follow-up study.J Reprod Med 1981,26:66–72Google Scholar
  6. 6.
    Hellberg D, Axelsson O, Gad A, Nilsson S. Conservation management of the abnormal smear during pregnancy. A long-term follow-up.Acta Obstet Gynecol Scand 1987,66:195–9Google Scholar
  7. 7.
    McGee JE, Sala JM. Carcinoma of the cervix and pregnancy.J Iowa State Med Soc 1960, VolL, 12:717–21Google Scholar
  8. 8.
    Gustafsson DC, Kottmeier HL. Carcinoma of the cervix associated with pregnancy.Acta Obstet Gynecol Scand 1962,41:1–21Google Scholar
  9. 9.
    Dudan RC, Yon Jr JL, Ford Jr JH, Averette HE. Carcinoma of the cervix and pregnancy.Gynecol Oncol 1973,1:283–9Google Scholar
  10. 10.
    Nisker JA, Shubat M. Stage 1B cervical carcinoma and pregnancy: Report of 49 cases.Am J Obstet Gynecol 1983,145:203–6Google Scholar
  11. 11.
    Hannigan EV. Cervical cancer in pregnancy.Clin Obst Gynec 1990,33:837–45Google Scholar
  12. 12.
    Duggan B, Muderspach LI, Roman LD et al. Cervical cancer in pregnancy: Reporting on planned delay in therapy.Obstet Gynecol 1993,82:598–602Google Scholar
  13. 13.
    Sivanesaratnam V, Jayalakshmi P, Loo C. Surgical management of early invasive cancer of the cervix associated with pregnancy.Gynecol Oncol 1993,48:68–76Google Scholar
  14. 14.
    Békássy Z, Alm P, Grundsell H et al. Laser miniconization in mild and moderate dysplasia of the uterine cervix.Gynecol Oncol 1983,15:357–62Google Scholar
  15. 15.
    Békássy Z, Alm P, Grundsell H et al. Laser minikonisation—eine neue methode zur behandlung der leichten und mässigen zervixdysplasie.Zentralol Gynákol 1983,105:1374–7Google Scholar
  16. 16.
    Békássy Z, Alm P, Grundsell H et al. Letters to the Editor. Reply to Dr. Rubinstein.Gynecol Oncol 1984,18:132–3Google Scholar
  17. 17.
    Logsdon-Pokorny VK. Gynecologic surgery during pregnancy. In: Pitkin MR, Scott JR (eds)Surgical Diseases in Pregnancy. J. B. Lippincott Co., 1994, 294–305Google Scholar
  18. 18.
    Grundsell H, Larsson G, Békássy Z. Use of an antifibrinolytic agent (tranexamic acid) and lateral sutures with laser conization of the cervix.Obstet Gynecol 1984,64:573–6.Google Scholar
  19. 19.
    Novak ER, Woodruff JD. Cervical neoplasia. In:Novak's Gynecologic and Obstetric Pathology, With Clinical and Endocrine Relations, 8th edn. London: W B Saunders, 1979:111–56Google Scholar
  20. 20.
    International Federation of Gynecology and Obstetrics. Changes in definitions of clinical staging for carcinoma of the cervix and ovary. Announcement.Am J Obstet Gynecol 1987,156:263–4Google Scholar
  21. 21.
    Hannigan EV, Whitehouse III HH, Atkinson WD, Becker SN. Cone biopsy during pregnancy.Obstet Gynecol 1982,60:450–5Google Scholar
  22. 22.
    Gustavii B. Chorionic biopsy and miscarriage in first trimester.Lancet 1984,i:562Google Scholar
  23. 23.
    Gilmore DH, McNay MB. Spontaneous fetal loss rate in early pregnancy.Lancet 1985,i:107Google Scholar
  24. 24.
    McFadyen IR. Missed abortion and later spontaneous abortion in pregnancies clinically normal at 7–12 wk.Europ J Obstet Gynec Reprod Biol 1985,20:381–4Google Scholar
  25. 25.
    Wilson RD, Kendrick V, Wittmann BK, McGillivray. Spontaneous abortion and pregnancy outcome after normal first-trimester ultrasound examination.Obstet Gynecol 1986,67:352–5Google Scholar
  26. 26.
    Laudañski T, Åkerlund M. Uterine effects of N-a-triglycyl-(8-lysine)-vasopressin and 8-lysine-vasopressin in the first trimester of pregnancy.Contraception 1980,22:199–208Google Scholar
  27. 27.
    Lindoff C, Rybo G, Åstedt B. Treatment with tranexamic acid during pregnancy, and the risk of thrombo-embolic complications.Thromb Haemost 1993,70: 238–40Google Scholar
  28. 28.
    Benedet JL, Selke PA, Nickerson KG. Colposcopic evaluation of abnormal Papanicolaou smears in pregnancy.Am J Obstet Gyneco 1987,157:15932–7Google Scholar
  29. 29.
    LaPolla JP, O'Neill Ch, Wetrich D. Colposcopic management of abnormal cervical cytology in pregnancy.J. Reprod Med 1988,33:301–6Google Scholar

Copyright information

© W.B. Saunders Company Ltd 1995

Authors and Affiliations

  • Zoltán Békássy
    • 1
  • Constantin S. Iosif
    • 1
  • Birger Åstedt
    • 1
  1. 1.Department of Obstetrics and GynaecologyUniversity of Lund, University HospitalLundSweden

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