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Case 25 - A 28-Year-Old P0 Woman with Adenocarcinoma In Situ Has Intraoperative Bleeding during a Cold-Knife Conization

Published online by Cambridge University Press:  19 November 2021

By
Seine Chiang
Edited by
Todd R. Jenkins ,
Lisa Keder ,
Abimola Famuyide ,
Kimberly S. Gecsi  and
David Chelmow
Todd R. Jenkins
Affiliation:
University of Alabama, Birmingham
Lisa Keder
Affiliation:
Ohio State University School of Medicine, Columbus
Abimola Famuyide
Affiliation:
Mayo Clinic, Rochester
Kimberly S. Gecsi
Affiliation:
Medical College of Wisconsin
David Chelmow
Affiliation:
Virginia Commonwealth University School of Medicine
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Summary

A 28-year-old female para 0, non-smoker, presents to discuss management of adenocarcinoma in situ (AIS) on colposcopic biopsy. She has been in a mutually monogamous relationship for the past four years, has had two lifetime partners, and uses combined oral contraceptive pills (COCs; ethinyl estradiol 20 mcg/norethindrone 1 mg PO daily) for contraception. She has no past surgical history and no known drug allergies. She had a normal wellness examination three months ago and completed the HPV vaccination series at age 26. Her past medical history is significant for abnormal Pap smear. Her cervical cancer screening history is as follows:

Keywords

cold knife conizationhemorrhagecervical dysplasiaadenocarcinoma in situ
Type
Chapter
Information
Surgical Gynecology
A Case-Based Approach
 , pp. 70 - 73
Publisher: Cambridge University Press
Print publication year: 2021

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References

Teoh, D, Musa, F, Salani, R, Huh, W, Jimenez, E. Diagnosis and management of adenocarcinoma in situ. A Society of Gynecologic Oncology Evidence-based Review and Recommendations. Obstet Gynecol 2020; 135(4): 869–78.Google Scholar
Baggish, MS. Anatomy of the cervix. In: Baggish, MS, Karram, MM, eds., Atlas of Pelvic Anatomy and Gynecologic Surgery, 4th ed. Philadelphia: Elsevier Inc. 2016; 493–7.Google Scholar
Baggish, MS. Conization of the cervix. In: Baggish, MS, Karram, MM, eds., Atlas of Pelvic Anatomy and Gynecologic Surgery, 4th ed. Philadelphia: Elsevier Inc. 2016; 505–18.Google Scholar
Jiang, Y, Chen, C, Li, L. Comparison of cold-knife conization versus loop electrosurgical excision for adenocarcinoma in situ (ACIS): a systematic review and meta-analysis. PLoS One 2016; 12(1): 1–12.Google Scholar
Kyrgiou, M, Koliopoulos, G, Martin-Hirsch, P, et al. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 2006; 367: 489–98.CrossRefGoogle ScholarPubMed
Liu, Y, Qiu, HF, Tang, Y, Chen, J, Lv, J. Pregnancy outcome after the treatment of loop electrosurgical excision procedure or cold knife conization for cervical intraepithelial neoplasia. Gynecol Obstet Invest 2014; 77: 240–4.CrossRefGoogle ScholarPubMed
Martin-Hirsch, PP, Bryant, A. Interventions for preventing blood loss during the treatment of cervical intraepithelial neoplasia (Review). Cochrane Database Syst Rev 2013; 2013(12): CD001421.Google Scholar

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