Cone biopsy and LLETZ

LLETZ and cone biopsy are both treatments to remove abnormal cells in cervical area. LLETZ stands for Large Loop Excision of the Transformation Zone.

Diagram of cone biopsy

LLETZ and cone biopsy are performed if you have abnormal cervical screening test results (changes in the cells covering the cervix).

During the investigation following your test result (called a colposcopy), a small sample of cells may be taken. The results may show CIN. CIN is cervical intraepithelial neoplasia. It is not cancer. There are 3 levels of CIN and they relate to how deep into the skin the abnormal cells have gone.

  • CIN 1 – up to one third of the thickness of the lining covering the cervix has abnormal cells
  • CIN 2 – between one third and two thirds of the skin covering the cervix has abnormal cells
  • CIN 3 – the full thickness of the lining covering the cervix has abnormal cells

LLETZ

In the LLETZ procedure a thin wire loop heated by an electrical current is used to remove the abnormal tissue from the cervix. It is a quick procedure, usually done under a local anaesthetic. The tissue sample is sent to a laboratory for examination. 

Cone biopsy

A cone biopsy is so called because a cone-shaped piece of tissue is surgically removed from the cervix. The cone biopsy is usually done under a general anaesthetic and involves a day or overnight stay in hospital. Results are usually available in a week. 

The risk of premature birth

Women who had have a cone biopsy or a LLETZ procedure, or any other procedure that involves the removal of cells from the cervix before pregnancy, are at higher risk of having a late miscarriage or premature birth (before 37 weeks).

The level of risk depends on the extent of the procedure that was carried out. Evidence shows that in cases where the excision is more than 10mm, or if more than one procedure has been carried out, then the risk is increased. 

It is important to let the midwife know at your first booking appointment if you have had any type of procedure performed on your cervix. 

More research is needed to assess the impact of these cervical procedures on pregnancy and at the moment there are no national guidelines on care, so different NHS trusts may offer different care.

Other causes of premature birth

  • Itching hands

    Intraheptic cholestasis of pregnancy (ICP)

    Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC), is a liver disorder that can develop during pregnancy.

  • Doctor taking pregnant woman's blood pressure.

    Pre-eclampsia and premature birth

    Pre-eclampsia is a serious condition that only occurs during pregnancy, typically after 20 weeks. It is a combination of hypertension (high blood pressure) and proteinuria (protein in your urine).

  • Profile of pregnant woman drawn in chalk on black board.

    Intrauterine infection (chorioamnionitis)

    Intrauterine infection, also known as chorioamnionitis, is infection within the womb.

  • Pregnant woman being checked by midwife.

    Fetal growth restriction (Intrauterine growth restriction)

    Fetal growth restriction (FGR) is a condition where a baby is smaller than expected or when a baby's growth slows or stops during pregnancy. It is also called intrauterine growth restriction (IUGR).

  • Woman with diabetes in pregnancy talking to health professional.

    Type 1 or 2 diabetes in pregnancy

    There are risks in every pregnancy, but if you have type 1 or 2 diabetes the risks are higher for both mother and the baby. However, there are lots of things you can do to reduce the risks and give your baby the best possible start in life.

  • Premature baby.

    Lifestyle factors and premature birth

    The way your life is lived can have an effect on your risk of premature birth.

  • Pregnant woman talking to health professional.

    Antiphospholipid syndrome (APS)

    Antiphospholipid syndrome is an immune system disorder. It can cause pregnancy complications, but treatment can help to reduce the risks for you and your baby.

  • Pregnant woman being checked by health professional.

    Uterine abnormality - problems with the womb

    Some women have a congenital uterine abnormality, which is a womb/uterus that formed in an unusual way before birth.

  • Infographic of cervical stitch

    Cervical incompetence

    When the cervix shortens and opens in the second trimester (16 to 24 weeks) or early in the third trimester without any other symptoms of labour it may be referred to as cervical incompetence or cervical insufficiency.

  • Infographic of PPROM

    Waters breaking early (PPROM)

    Preterm prelabour rupture of membranes (PPROM) is when your waters break before 37 weeks of pregnancy. If this happens, you will need to get medical help straight away.

  • Plancental abruption infographic

    Information about placental abruption

    The placenta is your baby’s support system in the womb. If your placenta doesn’t work properly, your baby is at risk of health problems. Placental abruption is when your placenta comes away from the wall of your womb.

  • Clinician scanning a pregnant woman

    Low-lying placenta (placenta praevia)

    The placenta is your baby’s support system in the womb. If the placenta doesn’t work properly, your baby is at risk of health problems.

Sources

NHS Choices (accessed Nov 2016, Next review due: 15/12/2016) Colposcopy - Treatment  http://www.nhs.uk/conditions/colposcopy/Pages/Treatment.aspx

RCOG (2016) Reproductive Outcomes after Local Treatment for Preinvasive Cervical Disease, Royal College of Obstetricians and Gynaecologists, London https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_21.pdf

Cancer research UK (Accessed Nov 2016. Updated: 2 June 2014, No review date given) Pregnancy and abnormal cervical cells. http://www.cancerresearchuk.org/about-cancer/type/cervical-cancer/smears...

Hide details

    Last reviewed on December 14th, 2017. Next review date December 17th, 2020.

    Was this information useful?

    Yes No