Factors influencing persistence or recurrence of cervical intraepithelial neoplasia after loop electrosurgical excision procedure.

OBJECTIVE: The purpose of this study was to determine the predictors of persistent or recurrent cervical intraepithelial neoplasia (CIN) after a loop electrosurgical excision procedure (LEEP) procedure in an urban population of low socioeconomic status. METHODS: A database was created using information about LEEPs done between October 2004 and December 2008 at John H. Stroger Jr. Hospital, Cook County. This information was then analyzed using χ2 test to determine the predictors of persistent or recurrent CIN. RESULTS: A total of 769 LEEPs were performed during the study period, and 52 were excluded secondary to ineligible entries, index cytology report not recorded, or incorrect medical record numbers. Persistent or recurrent disease was defined as cytology of atypical squamous cells cannot rule out high grade lesion (ASC-H) or worse without a histology, or histology of CIN 1 or worse, at any time after the LEEP was performed. Of our study population, 64.7% had a follow-up cytology or biopsy performed. Of these women, 24.7% had persistent or recurrent disease. The preoperative factors, namely positive human immunodeficiency virus serostatus (p < .0001) and a preoperative endocervical curettage that was positive for neoplasia (p < .0001), and postoperative factors, namely positive margin status (p < .0001) and high-grade pathology on the LEEP specimen (p < .0001), were significantly associated with persistent or recurrent disease. A high-grade preoperative cytology, a high-grade preoperative cervical biopsy, or the type of procedure performed (single specimen or separate endocervical pass) was not significantly associated with persistent or recurrent disease. CONCLUSIONS: In our population, adherence with follow-up was poor, and the rate of persistence or recurrence was high. In a limited resource setting such as ours, patients with significant predictors of persistence/recurrence such as human immunodeficiency virus seropositivity, endocervical disease, and high-grade pathology or positive margins on LEEP specimens should be targeted for closer surveillance.

Use of misoprostol for pregnancy termination in women with prior classical cesarean delivery: a report of 3 cases.

BACKGROUND: Misoprostol has been used for induction of labor either as a cervical ripening agent or as an abortifacient. Its use in women with previous cesarean births may be associated with an increased risk of uterine rupture. CASE: We describe 3 cases of pregnancy termination between 18 and 24 weeks' gestation in women with previous classical cesarean deliveries. Misoprostol was used successfully in all three cases without complications. CONCLUSION: Judicious use of misoprostol results in successful pregnancy termination in women with previous classical cesarean deliveries without uterine rupture.

Histology of loop electrosurgical excision procedures performed on women younger than 21 years and 65 years or older.

OBJECTIVE: To examine the prevalence and histology of loop electrosurgical excision procedures (LEEPs) done on women who are outside the age limits of the updated guidelines for cervical cytologic screening. MATERIALS AND METHODS: A database of all LEEPs performed between October 2004 and November 2009 was created. All data on age, human immunodeficiency virus status, cytology and histology before the procedure, and histology of the LEEP specimen were collected. RESULTS: There were 939 LEEPs performed during the study period, and data on 64 cases were excluded because of inadequate information. Fifty-four LEEPs were performed on women who were either younger than 21 years and those 65 years or older. All LEEPs were performed under traditionally accepted indications, except for 1 LEEP, which was excluded. None of the women gave a history of human immunodeficiency virus infection, and none of the older women had a history of abnormal cervical cytologic result before the index case. Of the procedures performed on the adolescents, 24 demonstrated high-grade lesions on LEEP (51.1%). Of the 6 procedures performed on older women, 4 LEEP specimens demonstrated high-grade lesions (66.7%). There were no cancers. CONCLUSIONS: We treated many women with LEEP excision who would not have been screened using current 2009 guidelines. Most of these women had high-grade lesions. The new guidelines may not be applicable to all population groups.

A comparison of loop electrosurgical excision procedures between human immunodeficiency virus-seropositive and -seronegative women.

OBJECTIVE: The purpose of this study was to compare preoperative and postoperative factors between human immunodeficiency virus (HIV)-seropositive and -seronegative women having a loop electrosurgical excision procedure (LEEP). Our hypothesis is that cervical intraepithelial neoplasia (CIN) presents differently in immunocompromised women. MATERIALS AND METHODS: A database of LEEPs performed from October 2004 to November 2009 at John H. Stroger Jr. Hospital, Cook County, Illinois, was created. Patients were considered to have persistent/recurrent disease if they had a cytological diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, or worse with no histology or a histological diagnosis of CIN 1 or worse at any time after their LEEP. χ2 Analysis was performed to evaluate differences between HIV-seropositive and -seronegative women. RESULTS: There were 886 LEEPs performed during the study period, 92 among HIV-seropositive and 794 among HIV-seronegative women. Overall, 64.7% had any cytology or histology performed after their procedure, and seropositive women were more likely to follow up (p = .004). Preoperative cytological and cervical histological diagnoses were not different between seropositive and negative women; however, a preoperative endocervical curettage, which was positive, was more common among seropositive women (p < .0001). Human immunodeficiency virus-seropositive women were more likely to have CIN on LEEP histology (p = .04), and more likely to have positive margins (p < .0001) and recurrent/persistent disease (p < .0001). CONCLUSIONS: The spectrum of cervical disease was very different between HIV-seropositive and -negative women having LEEPs in our study. Practitioners managing HIV-infected women should be aware of these differences and counsel and follow up appropriately.

Reproductive health assessment for women with cancer: a pilot study.

OBJECTIVE: The purpose of this study was to pilot a survey instrument and to develop descriptive data about the reproductive goals of reproductive-aged women (15-44 years) with cancer. STUDY DESIGN: This was a cross-sectional pilot survey study of 20 women who were diagnosed with various types of cancers at the oncology clinic of Stroger Hospital of Cook County, Chicago, from January-July 2006. RESULTS: Of the 20 patients whose cases were surveyed, the mean age was 36.6 years, and 90% of the women had breast cancer. Ten percent of patients would continue pregnancy, if they became pregnant while receiving treatment. Contraception was used by 55% of patients (n = 11), of whom 55% of the women (n = 6) were using abstinence. CONCLUSION: The result of this pilot study demonstrates the need for reproductive health counseling in women with cancer; the range of discussion must include fertility interest, contraception, and fertility preservation.