The short term complications and experiences of women after large loop excision of the transformation zone at CHBAH

Abstract

Prevention of cervical cancer in SA became a National priority in 2003 and guidelines for screening using the Papanicolaou (Pap) smear was introduced. Women with abnormal Pap smears are referred to colposcopy according to national guidelines. Chris Hani Baragwanath Academic Hospital has a see and treat policy where all women who are referred are evaluated and when the colposcopy findings are that of a CIN2 or more severe a Large Loop Excision of the Transformation zone is performed. The complications and experience of women in this setting is unknown Objectives The main objective of this study was to evaluate the experiences, immediate and early complications following colposcopy and a LLETZ procedure. Methods This was a prospective, descriptive study. Demographic data, contraceptive use, HIV status, cytology findings and histology results were extracted from the clinic database in 150 women who had a LLETZ performed. A questionnaire was used to record women‟s experiences and the complications of the procedure. A VAS score was used to quantify pain

Results The mean age was 40.41(SD±9.51), the mean parity 2.17(SD±1.34). Eighty- three (55%) women were HIV positive. The mean CD4+ count was 366.90μl/?? (SD±214.90),.Of 120 women who answered the question about smoking, 12(10%) were smokers. The cytology was reported as normal (1(0.74%)), ASCUS (4(2.66%)), ASC-H (10(6.67%), LSIL (18(12.00%)), HSIL (86(57.33)), AGUS (1(0.74%)) , suspected invasion (4(2.96%)), and squamous cell carcinoma (1(0.74%). Pap smears had not been recorded in (25(16.67%)) patients. There were 115 women who had a complete colposcopy diagnosis recorded. This was normal (3(2.08%)), CIN1 (22(19.13%)), CIN2 (50(43.48%)), CIN3 (27(23.48%)), and micro invasion (3(2.00%)). Histology results were available for 144 patients after LLETZ, 2(1.39%) had normal histology, 49(34.03%) women had CIN1, 35(24.31%) had CIN2, 54(37.50%) had CIN3, 1(0.68%) had micro invasion and 3(2.08%) women had a malignancy. Fifty women (33.33%) reported pain, 121 (80.67%) bleeding, and 94(62.67%) had a discharge in the 4 weeks after the procedure Eighty-Five (56.07%) women were anxious, 1(0.67%) was feeling bad about the results, the biggest fear among patients was cancer (55,08%), only 1(0.67%) had a bad experience with the actual colposcopy, and more than 90% of patients said that they preferred local anaesthesia over general anaesthesia. Conclusion Pap smear screening, colposcopy and treatment are associated with medical and emotional morbidity. This has to be balanced with a proven reduction in cervical cancer.